MEDICARE: VINOD MISHRA MD FACG A PROFESSIONAL CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	A38396	CA

General Provider Information

NPI Number	:	1396893863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VINOD MISHRA MD FACG A PROFESSIONAL CORP

Provider Business Mailing Address
First Line	:	6958 BROCKTON AVE STE 201
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-3802
Country	:	US
Telephone Number	:	951-784-6790
Fax Number	:	951-784-9919

Provider Business Practice Location Address
First Line	:	6958 BROCKTON AVE STE 201
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-3802
Country	:	US
Telephone Number	:	951-784-6790
Fax Number	:	951-784-9919

Authorized Official
Title or Position	:	OWNER
Name	:	VINOD MISHRA
Credential	:	MD
Telephone Number	:	951-784-6790

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	08/22/2020

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