Provider Demographics
NPI:1376658047
Name:MONARCH MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MONARCH MEDICAL CORPORATION
Other - Org Name:SHUMAN MEDICAL CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:SHUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-698-8554
Mailing Address - Street 1:40700 CALIFORNIA OAKS RD
Mailing Address - Street 2:207
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5789
Mailing Address - Country:US
Mailing Address - Phone:951-698-8554
Mailing Address - Fax:951-698-8556
Practice Address - Street 1:40700 CALIFORNIA OAKS RD
Practice Address - Street 2:207
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5789
Practice Address - Country:US
Practice Address - Phone:951-698-8554
Practice Address - Fax:951-698-8556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47796302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1164400834OtherNPI NUMBER
CA00G477960Medicare ID - Type UnspecifiedLICENCE