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General NPI Number Information
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NPI Number | 1336356690
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Entity Type | Organization
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Legal Business Name | TERRACINA MEDICAL CLINIC INC
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 10/31/2023
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Provider Practice Location Address
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Address Line | 34636 COUNTY LINE RD SUITE 32
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City | YUCAIPA
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State | CA
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Zip | 92399-5393
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Country | US
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Telephone | 909-795-9355
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Fax | 909-795-9439
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Provider Business Mailing Address
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Address Line | 34636 COUNTY LINE RD STE 32
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City | YUCAIPA
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State | CA
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Zip | 92399-5393
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Country | US
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Telephone | 909-795-9355
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Fax | 909-795-9439
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Authorized Official
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Title or Position | OWNER
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Name | MAGED G SAMAAN
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Credential | DO
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Telephone | 909-795-9355
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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 | A65841
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License Number State | CA
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