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General NPI Number Information
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NPI Number | 1629247556
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Entity Type | Organization
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Legal Business Name | HEMET EXPRESS CARE
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Dates
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Enumeration Date | 02/25/2008
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Last Update Date | 02/25/2008
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Provider Practice Location Address
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Address Line | 2627 W FLORIDA AVE 207
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City | HEMET
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State | CA
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Zip | 92545-3605
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Country | US
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Telephone | 951-929-1700
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Fax | 951-929-1779
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Provider Business Mailing Address
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Address Line | 2627 W FLORIDA AVE 207
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City | HEMET
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State | CA
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Zip | 92545-3605
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Country | US
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Telephone | 951-929-1700
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Fax | 951-929-1779
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Authorized Official
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Title or Position | OFFICER
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Name | DR. RODAS A FERNANDO
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Credential | M.D.
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Telephone | 951-929-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A40419
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License Number State | CA
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