Provider Demographics
NPI:1164617940
Name:TOTAL FAMILY MEDICAL CENTER OF LAKE ELSINORE
Entity Type:Organization
Organization Name:TOTAL FAMILY MEDICAL CENTER OF LAKE ELSINORE
Other - Org Name:TEMECULA URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NA'IMAH
Authorized Official - Middle Name:D
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-308-4451
Mailing Address - Street 1:41715 WINCHESTER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-4808
Mailing Address - Country:US
Mailing Address - Phone:951-308-4451
Mailing Address - Fax:
Practice Address - Street 1:41715 WINCHESTER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-4808
Practice Address - Country:US
Practice Address - Phone:951-308-4451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72993261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF24057Medicare UPIN