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NPI Code Detail

MEDICARE: SOUTHERN CALIFORNIA PRIMARY CARE CANYON LAKE URGENT & FAMILY CARE

MEDICARE: SOUTHERN CALIFORNIA PRIMARY CARE CANYON LAKE URGENT & FAMILY CARE
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
1332900000XNon-Pharmacy Dispensing SiteA48943CA

General Provider Information

NPI Number : 1710242474
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHERN CALIFORNIA PRIMARY CARE CANYON LAKE URGENT & FAMILY CARE
Provider Business Mailing Address
First Line : 5626 OBERLIN DR
Second Line : SUITE 110
City : SAN DIEGO
State : CA
Zip : 92121-1705
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 31581 CANYON ESTATES DR
Second Line :
City : LAKE ELSINORE
State : CA
Zip : 92532-0424
Country : US
Telephone Number : 951-244-3500
Fax Number :
Authorized Official
Title or Position : VP OPS
Name : KENNY HEINE
Credential :
Telephone Number : 858-964-1506
Provider Enumeration Date : 07/09/2012
Last Update Date : 10/25/2012

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Directions to “SOUTHERN CALIFORNIA PRIMARY CARE CANYON LAKE URGENT & FAMILY CARE ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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