Provider Demographics
NPI:1477527398
Name:TEMECULA CA ENDOSCOPY ASC LP
Entity Type:Organization
Organization Name:TEMECULA CA ENDOSCOPY ASC LP
Other - Org Name:TEMECULA VALLEY ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLENDENIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:25150 HANCOCK AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5987
Mailing Address - Country:US
Mailing Address - Phone:951-698-8805
Mailing Address - Fax:951-698-8898
Practice Address - Street 1:25150 HANCOCK AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5987
Practice Address - Country:US
Practice Address - Phone:951-698-8805
Practice Address - Fax:951-698-8898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250000810261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0612336Medicaid
CAZZZ31758ZMedicare PIN
CA0612336Medicaid