MEDICARE: PACIFIC FAMILY MEDICAL 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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1740878768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC FAMILY MEDICAL INC

Provider Business Mailing Address
First Line	:	9818 CAMINO DEL CORONADO
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92557-3549
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	191 E ALESSANDRO BLVD # 9A
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92508-5095
Country	:	US
Telephone Number	:	951-338-9707
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	DARREN THOMPSON
Credential	:
Telephone Number	:	909-222-9775

Provider Enumeration Date	:	01/05/2021
Last Update Date	:	01/05/2021

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