Provider Demographics
NPI:1770659278
Name:HARVEY A NURICK MD INC
Entity Type:Organization
Organization Name:HARVEY A NURICK MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:
Authorized Official - Last Name:NURICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-276-9012
Mailing Address - Street 1:7111 INDIANA AVE # 100
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-4543
Mailing Address - Country:US
Mailing Address - Phone:951-276-9012
Mailing Address - Fax:951-276-9163
Practice Address - Street 1:7111 INDIANA AVE # 100
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-4543
Practice Address - Country:US
Practice Address - Phone:951-276-9012
Practice Address - Fax:951-276-9163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC414540208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1720041486OtherMEDICARE INDIVIDUAL NPI
CA1568425239OtherMEDICARE INDIVIDUAL NPI
CA1639132392OtherMEDICARE INDIVIDUAL NPI
CAGR0085650Medicaid
ZZZ00662ZOtherBLUE SHIELD GROUP ID
CA0PA16997BMedicare PIN
CA00A771650Medicare PIN
CA1639132392OtherMEDICARE INDIVIDUAL NPI
CA1568425239OtherMEDICARE INDIVIDUAL NPI