Provider Demographics
NPI:1437595873
Name:MORENO VALLEY COMMUNITY MEDICAL GROUP
Entity Type:Organization
Organization Name:MORENO VALLEY COMMUNITY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PENGSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-243-6460
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92556-0220
Mailing Address - Country:US
Mailing Address - Phone:951-243-6460
Mailing Address - Fax:951-243-5871
Practice Address - Street 1:23180 HEMLOCK AVE STE 201
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-8001
Practice Address - Country:US
Practice Address - Phone:951-243-6460
Practice Address - Fax:951-243-5871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-13
Last Update Date:2022-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapyGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty