Provider Demographics
NPI:1508012576
Name:THOROCOR MEDICAL ENTERPRISES, INC.
Entity Type:Organization
Organization Name:THOROCOR MEDICAL ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANCEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-367-7600
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92693-1475
Mailing Address - Country:US
Mailing Address - Phone:951-367-7600
Mailing Address - Fax:
Practice Address - Street 1:3903 BROCKTON AVE
Practice Address - Street 2:SUITE TWO
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3212
Practice Address - Country:US
Practice Address - Phone:951-367-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43151208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty