Provider Demographics
NPI:1467097121
Name:PERFORMANCE MEDICAL MANAGEMENT, INC
Entity Type:Organization
Organization Name:PERFORMANCE MEDICAL MANAGEMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:P LOUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-737-3733
Mailing Address - Street 1:1240 E ONTARIO AVE STE 102-303
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-8671
Mailing Address - Country:US
Mailing Address - Phone:951-737-3733
Mailing Address - Fax:
Practice Address - Street 1:10399 LEMON AVE STE 103
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91737-3771
Practice Address - Country:US
Practice Address - Phone:909-989-1911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-16
Last Update Date:2019-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty