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General NPI Number Information
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NPI Number | 1831408061
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Entity Type | Organization
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Legal Business Name | MULTISPECIALITY AND OCCUPATIONAL INJURY MEDICAL CENTER A MED CORP
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Dates
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Enumeration Date | 10/06/2010
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Last Update Date | 03/07/2011
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Provider Practice Location Address
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Address Line | 703 MAGNOLIA AVE
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City | CORONA
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State | CA
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Zip | 92879-3118
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Country | US
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Telephone | 951-340-2178
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Fax | 951-340-2478
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Provider Business Mailing Address
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Address Line | 703 MAGNOLIA AVE
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City | CORONA
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State | CA
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Zip | 92879-3118
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Country | US
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Telephone | 951-340-2178
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Fax | 951-340-2478
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Authorized Official
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Title or Position | OFFICE MANAGER/BILLER
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Name | STELLA ARA
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Credential |
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Telephone | 951-340-2178
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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 | A70230
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A68736
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License Number State | CA
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