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General NPI Number Information
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NPI Number | 1982083127
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Entity Type | Organization
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Legal Business Name | TIBBETTS MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 05/20/2015
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Last Update Date | 06/23/2020
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Provider Practice Location Address
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Address Line | 9041 MAGNOLIA AVE SUITE 107
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City | RIVERSIDE
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State | CA
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Zip | 92503-3900
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Country | US
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Telephone | 951-353-1021
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Fax | 951-687-0692
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Provider Business Mailing Address
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Address Line | 9041 MAGNOLIA AVE SUITE 107
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City | RIVERSIDE
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State | CA
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Zip | 92503-3900
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Country | US
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Telephone | 951-353-1021
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Fax | 951-710-1964
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JENNIFER CHAPMAN
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Credential |
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Telephone | 951-353-1021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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