Provider Demographics
NPI:1427194802
Name:CORNERSTONE WOMEN'S HEALTHCARE A MEDICAL CORP
Entity Type:Organization
Organization Name:CORNERSTONE WOMEN'S HEALTHCARE A MEDICAL CORP
Other - Org Name:CORNERSTONE WOMEN'S HEALTHCARE A MEDICAL CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:ANDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-894-7555
Mailing Address - Street 1:24619 WASHINGTON AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-8228
Mailing Address - Country:US
Mailing Address - Phone:951-894-7555
Mailing Address - Fax:951-894-7575
Practice Address - Street 1:24619 WASHINGTON AVE STE 104
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-8228
Practice Address - Country:US
Practice Address - Phone:951-894-7555
Practice Address - Fax:951-894-7575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG083821207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G83821Medicaid
CA00G83821Medicaid