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General NPI Number Information
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NPI Number | 1902167521
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Entity Type | Organization
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Legal Business Name | CIMA
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Dates
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Enumeration Date | 05/30/2012
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Last Update Date | 05/30/2012
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Provider Practice Location Address
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Address Line | 1655 E 6TH ST STE A4C
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City | CORONA
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State | CA
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Zip | 92879-1719
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Country | US
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Telephone | 951-278-3581
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Fax |
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Provider Business Mailing Address
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Address Line | 1191 MAGNOLIA AVE STE D-336
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City | CORONA
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State | CA
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Zip | 92879-3215
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Country | US
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Telephone | 951-278-3581
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Fax | 951-278-3896
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARTIN JOSEPH PRYAL
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Credential | D.C.
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Telephone | 951-278-3581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 648037
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License Number State | CA
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