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General NPI Number Information
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NPI Number | 1467280990
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Entity Type | Organization
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Legal Business Name | ALERTIVE HEALTHCARE MEDICAL GROUP APC
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Dates
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Enumeration Date | 07/25/2024
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 4500 BROCKTON AVE STE 305
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City | RIVERSIDE
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State | CA
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Zip | 92501-4027
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Country | US
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Telephone | 951-466-6628
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Fax |
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Provider Business Mailing Address
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Address Line | 32605 TEMECULA PKWY STE 205
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City | TEMECULA
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State | CA
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Zip | 92592-6839
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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 | OWNER/AUTHORIZED OFFICIAL
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Name | SIVARAMAN K. GOUNDER
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Credential |
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Telephone | 908-361-0185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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