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General NPI Number Information
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NPI Number | 1144345158
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Entity Type | Organization
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Legal Business Name | CITRUS VALLEY
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 854 MAGNOLIA AVE STE 1010
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City | CORONA
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State | CA
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Zip | 92879-3109
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Country | US
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Telephone | 951-737-8141
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Fax |
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Provider Business Mailing Address
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Address Line | 1860 HAMNER AVE
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City | NORCO
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State | CA
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Zip | 92860-2945
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Country | US
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Telephone | 951-737-8177
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Fax |
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Authorized Official
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Title or Position | SYSTEMS MANAGER
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Name | WYNDI BLEEKER
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Credential |
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Telephone | 951-751-3150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A21618
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License Number State | CA
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