Provider Demographics
NPI:1659483352
Name:MORENO VALLEY PHYSICIANS ASSOCIATES, A MEDICAL CORP
Entity Type:Organization
Organization Name:MORENO VALLEY PHYSICIANS ASSOCIATES, A MEDICAL CORP
Other - Org Name:MORENO VALLEY CLINICA MEDICA FAMILIAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:OLACHEA-RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-616-1961
Mailing Address - Street 1:23080 ALESSANDRO BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-9674
Mailing Address - Country:US
Mailing Address - Phone:951-697-7866
Mailing Address - Fax:951-697-7869
Practice Address - Street 1:23080 ALESSANDRO BLVD STE 202
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-9674
Practice Address - Country:US
Practice Address - Phone:951-697-7866
Practice Address - Fax:951-697-7869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1659483352OtherNPI
CA1659483352OtherNPI