MEDICARE: MD SENIOR CARE MEDICAL GROUP, INC.

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician
2	302F00000X	Exclusive Provider Organization

General Provider Information

NPI Number	:	1447908264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MD SENIOR CARE MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	99 BUSINESS PARK DR
Second Line	:
City	:	PERRIS
State	:	CA
Zip	:	92571-3165
Country	:	US
Telephone Number	:	951-956-2131
Fax Number	:

Provider Business Practice Location Address
First Line	:	99 BUSINESS PARK DR
Second Line	:
City	:	PERRIS
State	:	CA
Zip	:	92571-3165
Country	:	US
Telephone Number	:	951-956-2131
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID HERNANDEZ-RODRIGUEZ
Credential	:	MD
Telephone Number	:	951-956-2131

Provider Enumeration Date	:	03/10/2022
Last Update Date	:	03/15/2022

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