Provider Demographics
NPI:1417050071
Name:TEMECULA VALLEY NUCLEAR MEDICAL CORPORATION
Entity Type:Organization
Organization Name:TEMECULA VALLEY NUCLEAR MEDICAL CORPORATION
Other - Org Name:TEMECULA VALLEY NUCLEAR MEDICINE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:METH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-698-4808
Mailing Address - Street 1:25485 MEDICAL CENTER DRIVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562
Mailing Address - Country:US
Mailing Address - Phone:951-698-4808
Mailing Address - Fax:951-698-4805
Practice Address - Street 1:25485 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 102
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-6900
Practice Address - Country:US
Practice Address - Phone:951-698-4808
Practice Address - Fax:951-698-4805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41717207UN0903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207UN0903XAllopathic & Osteopathic PhysiciansNuclear MedicineIn Vivo & In Vitro Nuclear MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E75064Medicare UPIN
CA00A417170Medicare ID - Type Unspecified