Provider Demographics
NPI:1760490569
Name:GERIATRIC PROFESSIONAL SERVICES INC.
Entity Type:Organization
Organization Name:GERIATRIC PROFESSIONAL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MUSTAFA
Authorized Official - Middle Name:
Authorized Official - Last Name:FIROZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-479-1980
Mailing Address - Street 1:6484 BRANCH CT
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-0801
Mailing Address - Country:US
Mailing Address - Phone:951-479-1980
Mailing Address - Fax:951-284-6281
Practice Address - Street 1:555 S 7TH AVE
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-3043
Practice Address - Country:US
Practice Address - Phone:760-256-1761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51487207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty