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General NPI Number Information
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NPI Number | 1215122213
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Entity Type | Organization
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Legal Business Name | WOODCREST MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 09/12/2007
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Last Update Date | 09/12/2007
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Provider Practice Location Address
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Address Line | 9041 MAGNOLIA AVE SUITE 105B
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City | RIVERSIDE
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State | CA
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Zip | 92503-3900
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Country | US
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Telephone | 951-351-7726
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Fax | 951-351-7730
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Provider Business Mailing Address
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Address Line | 9041 MAGNOLIA AVE SUITE 105B
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City | RIVERSIDE
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State | CA
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Zip | 92503-3900
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Country | US
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Telephone | 951-351-7726
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Fax | 951-351-7730
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Authorized Official
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Title or Position | PRESIDENT
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Name | PETER CONRAD PAUL
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Credential | M.D
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Telephone | 951-351-7726
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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 | A40030
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License Number State | CA
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