Provider Demographics
NPI:1033296231
Name:SOUTHLAND ARTHRITES AND OSTEOPOROSIS MEDICAL CENTER INC
Entity Type:Organization
Organization Name:SOUTHLAND ARTHRITES AND OSTEOPOROSIS MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENI
Authorized Official - Middle Name:C
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:951-672-1866
Mailing Address - Street 1:949 CALHOUN PL
Mailing Address - Street 2:SUITE F
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4403
Mailing Address - Country:US
Mailing Address - Phone:951-652-5000
Mailing Address - Fax:951-765-6688
Practice Address - Street 1:29798 HAUN RD
Practice Address - Street 2:SUITE 301
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92586
Practice Address - Country:US
Practice Address - Phone:951-672-1866
Practice Address - Fax:951-672-1886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ06779ZMedicare PIN
CAA28271Medicare UPIN
CA00A370441Medicare PIN