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General NPI Number Information
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NPI Number | 1790425833
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Entity Type | Organization
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Legal Business Name | MEDCO HEALTHCARE MEDICAL GROUP INC
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Dates
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Enumeration Date | 03/29/2022
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Last Update Date | 01/11/2024
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Provider Practice Location Address
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Address Line | 355 E RINCON ST STE 217
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City | CORONA
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State | CA
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Zip | 92879-1372
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Country | US
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Telephone | 951-256-4240
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Fax | 951-256-4241
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Provider Business Mailing Address
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Address Line | 355 E RINCON ST STE 217
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City | CORONA
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State | CA
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Zip | 92879-1372
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Country | US
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Telephone | 951-256-4240
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Fax | 951-256-4241
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Authorized Official
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Title or Position | PRESIDENT
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Name | ABDUL KHAN
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Credential | MD
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Telephone | 310-561-0915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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