MEDICARE: PARKSIDE 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	207R00000X	Internal Medicine Physician	A101427	CA
2	2084N0400X	Neurology Physician	A33406	CA

General Provider Information

NPI Number	:	1891935862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARKSIDE MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	1310 SAN BERNARDINO ROAD
Second Line	:	SUITE 102
City	:	UPLAND
State	:	CA
Zip	:	91786-4985
Country	:	US
Telephone Number	:	909-608-2008
Fax Number	:	909-608-7705

Provider Business Practice Location Address
First Line	:	1310 SAN BERNARDINO ROAD
Second Line	:	SUITE 102
City	:	UPLAND
State	:	CA
Zip	:	91786-4985
Country	:	US
Telephone Number	:	909-608-2008
Fax Number	:	909-608-7705

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MOHSEN IBRAHIM ALI
Credential	:	M.D.
Telephone Number	:	909-608-2008

Provider Enumeration Date	:	03/03/2009
Last Update Date	:	06/18/2015

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Directions to “PARKSIDE MEDICAL GROUP INC ” Practice Location

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