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General NPI Number Information
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NPI Number | 1255792800
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Entity Type | Organization
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Legal Business Name | SOUTHERN CALIFORNIA INTERNAL MEDICINE, INC.
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Dates
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Enumeration Date | 03/10/2016
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Last Update Date | 03/06/2017
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Provider Practice Location Address
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Address Line | 31805 TEMECULA PARKWAY SUITE 165
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City | TEMECULA
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State | CA
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Zip | 92592
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Country | US
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Telephone | 951-395-0681
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Fax | 951-346-4110
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Provider Business Mailing Address
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Address Line | 31805 TEMECULA PARKWAY SUITE 165
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City | TEMECULA
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State | CA
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Zip | 92592
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO AND PRESIDENT
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Name | DR. OSVALDO A LOPEZ
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Credential | MD
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Telephone | 951-219-9543
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | A61258
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License Number State | CA
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