Provider Demographics
NPI:1043692940
Name:MENIFEE VALLEY CARDIOLOGY,INC
Entity Type:Organization
Organization Name:MENIFEE VALLEY CARDIOLOGY,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HUMAYUN
Authorized Official - Middle Name:T
Authorized Official - Last Name:QURESHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-666-1243
Mailing Address - Street 1:28125 BRADLEY RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586-2248
Mailing Address - Country:US
Mailing Address - Phone:951-679-3131
Mailing Address - Fax:951-679-3133
Practice Address - Street 1:28125 BRADLEY RD
Practice Address - Street 2:SUITE 260
Practice Address - City:SUN CITY
Practice Address - State:CA
Practice Address - Zip Code:92586-2248
Practice Address - Country:US
Practice Address - Phone:951-679-3131
Practice Address - Fax:951-679-3133
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MENIFEE VALLEY CARDIOLOGY,INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51284261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD16412Medicare UPIN
CA00C512841Medicare PIN