Provider Demographics
NPI: | 1376918052 |
---|---|
Name: | MEDICAL PARTNERS OF HEMET VALLEY |
Entity Type: | Organization |
Organization Name: | MEDICAL PARTNERS OF HEMET VALLEY |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MD |
Authorized Official - Prefix: | |
Authorized Official - First Name: | WASEF |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | ATIYA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 951-940-9092 |
Mailing Address - Street 1: | 2581 W FLORIDA AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | HEMET |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92545-4615 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2581 W FLORIDA AVE |
Practice Address - Street 2: | |
Practice Address - City: | HEMET |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92545-4615 |
Practice Address - Country: | US |
Practice Address - Phone: | 951-658-7284 |
Practice Address - Fax: | 951-766-5004 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-12-07 |
Last Update Date: | 2015-12-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | F90616 | Medicare UPIN | |
CA | 00A238390 | Medicare UPIN |