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General NPI Number Information
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NPI Number | 1568517613
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Entity Type | Organization
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Legal Business Name | PHYSICIAN RX MGMT INC.
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 03/21/2008
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Provider Practice Location Address
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Address Line | 611 W GRAHAM AVE
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City | LAKE ELSINORE
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State | CA
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Zip | 92530-3516
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Country | US
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Telephone | 951-471-3578
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Fax | 951-245-4725
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Provider Business Mailing Address
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Address Line | 31500 GRAPE ST # 3-120
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City | LAKE ELSINORE
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State | CA
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Zip | 92532-9702
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Country | US
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Telephone | 951-471-3578
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Fax | 951-245-4725
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Authorized Official
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Title or Position | CEO
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Name | MRS. IRENE CABRAL
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Credential |
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Telephone | 951-471-3578
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 2621975
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License Number State | CA
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