Provider Demographics
NPI:1689604480
Name:MISSION FAMILY MEDICAL GROUP
Entity Type:Organization
Organization Name:MISSION FAMILY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LESTER
Authorized Official - Last Name:SCHOONMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-303-2277
Mailing Address - Street 1:31805 TEMECULA PARKWAY
Mailing Address - Street 2:STE 121
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592
Mailing Address - Country:US
Mailing Address - Phone:951-303-2277
Mailing Address - Fax:951-303-6432
Practice Address - Street 1:31720 TEMECULA PARKWAY
Practice Address - Street 2:STE-100
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592
Practice Address - Country:US
Practice Address - Phone:951-303-2277
Practice Address - Fax:951-303-6432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ26348ZMedicare PIN