Provider Demographics
NPI:1629247556
Name:HEMET EXPRESS CARE
Entity Type:Organization
Organization Name:HEMET EXPRESS CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:FERNANDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-929-1700
Mailing Address - Street 1:2627 W FLORIDA AVE
Mailing Address - Street 2:207
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92545-3605
Mailing Address - Country:US
Mailing Address - Phone:951-929-1700
Mailing Address - Fax:951-929-1779
Practice Address - Street 1:2627 W FLORIDA AVE
Practice Address - Street 2:207
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-3605
Practice Address - Country:US
Practice Address - Phone:951-929-1700
Practice Address - Fax:951-929-1779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40419208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA40419Medicare Oscar/Certification