MEDICARE: SOUTHERN COAST PSYCH MEDICAL ASSOCIATES PC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1467269068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN COAST PSYCH MEDICAL ASSOCIATES PC

Provider Business Mailing Address
First Line	:	33175 TEMECULA PKWY
Second Line	:	SUITE A-121
City	:	TEMECULA
State	:	CA
Zip	:	92592-7310
Country	:	US
Telephone Number	:	951-322-4532
Fax Number	:	844-314-9910

Provider Business Practice Location Address
First Line	:	903 E DEVONSHIRE AVE STE E
Second Line	:
City	:	HEMET
State	:	CA
Zip	:	92543-3097
Country	:	US
Telephone Number	:	951-322-4532
Fax Number	:	844-314-9910

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JENIFER BUCKLEY
Credential	:	NP
Telephone Number	:	957-466-7733

Provider Enumeration Date	:	12/17/2024
Last Update Date	:	06/11/2025

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