Provider Demographics
NPI:1417150848
Name:TEMECULA VALLEY OB GYN MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:TEMECULA VALLEY OB GYN MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ELFELT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-477-4748
Mailing Address - Street 1:25460 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5985
Mailing Address - Country:US
Mailing Address - Phone:951-677-4748
Mailing Address - Fax:951-677-6529
Practice Address - Street 1:25460 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5985
Practice Address - Country:US
Practice Address - Phone:951-677-4748
Practice Address - Fax:951-677-6529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0050580Medicaid
CAGR0050580Medicaid