Provider Demographics
NPI:1598857963
Name:ASPEN MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:ASPEN MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IHEANACHO
Authorized Official - Middle Name:
Authorized Official - Last Name:EMERUWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-343-3477
Mailing Address - Street 1:4000 14TH ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-4083
Mailing Address - Country:US
Mailing Address - Phone:951-788-6012
Mailing Address - Fax:951-788-6369
Practice Address - Street 1:4000 14TH ST
Practice Address - Street 2:SUITE 401
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4083
Practice Address - Country:US
Practice Address - Phone:951-788-6012
Practice Address - Fax:951-788-6369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0094762Medicaid