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General NPI Number Information
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NPI Number | 1437344538
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Entity Type | Organization
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Legal Business Name | SO. CAL. ENDO SURGICAL MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 09/11/2007
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Last Update Date | 09/11/2007
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Provider Practice Location Address
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Address Line | 3838 SHERMAN DR STE 6
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City | RIVERSIDE
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State | CA
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Zip | 92503-4001
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Country | US
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Telephone | 951-231-2402
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Fax | 951-688-8451
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Provider Business Mailing Address
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Address Line | PO BOX 1551
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City | RIVERSIDE
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State | CA
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Zip | 92502-1551
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Country | US
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Telephone | 951-231-2402
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Fax | 951-688-8451
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Authorized Official
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Title or Position | OWNER
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Name | AMOS W KUVHENGUHWA
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Credential | MD
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Telephone | 951-231-2402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | G59257
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License Number State | CA
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