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General NPI Number Information
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NPI Number | 1912829904
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Entity Type | Organization
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Legal Business Name | VIRTUE IPA
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Dates
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Enumeration Date | 07/29/2026
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Last Update Date | 07/29/2026
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Provider Practice Location Address
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Address Line | 27403 YNEZ RD STE 108
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City | TEMECULA
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State | CA
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Zip | 92591-4619
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Country | US
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Telephone | 951-394-7028
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Fax |
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Provider Business Mailing Address
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Address Line | 27403 YNEZ RD STE 110
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City | TEMECULA
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State | CA
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Zip | 92591-4615
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Country | US
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Telephone | 951-394-7028
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEREMY GOMER
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Credential | M.D
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Telephone | 951-394-7028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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