Provider Demographics
NPI:1053675793
Name:ECLIPSE MEDICAL GROUP
Entity Type:Organization
Organization Name:ECLIPSE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:ISERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-739-5944
Mailing Address - Street 1:500 S ANAHEIM HILLS RD STE 234
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-4760
Mailing Address - Country:US
Mailing Address - Phone:714-282-5437
Mailing Address - Fax:714-282-8724
Practice Address - Street 1:802 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3104
Practice Address - Country:US
Practice Address - Phone:951-739-5944
Practice Address - Fax:951-739-7480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty