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General NPI Number Information
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NPI Number | 1447793088
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Entity Type | Organization
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Legal Business Name | ORCHID MEDICAL GROUP
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Dates
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Enumeration Date | 11/30/2016
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Last Update Date | 03/31/2017
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Provider Practice Location Address
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Address Line | 395 TERRACINA BLVD
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City | REDLANDS
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State | CA
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Zip | 92373-4849
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Country | US
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Telephone | 951-323-1907
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Fax |
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Provider Business Mailing Address
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Address Line | 5917 SPEYSIDE RD
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City | RIVERSIDE
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State | CA
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Zip | 92507-8475
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Country | US
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Telephone | 951-323-1907
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Fax |
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Authorized Official
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Title or Position | ACCOUNT MANAGER
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Name | MARLISE NEGRETTE
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Credential |
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Telephone | 909-793-5511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A064957
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License Number State | CA
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