Provider Demographics
NPI:1821104688
Name:JOSEPH NEVAREZ MD CWS INC
Entity Type:Organization
Organization Name:JOSEPH NEVAREZ MD CWS INC
Other - Org Name:JOSEPH NEVAREZ MD CWS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:G
Authorized Official - Last Name:NEVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-615-0215
Mailing Address - Street 1:39252 WINCHESTER RD
Mailing Address - Street 2:STE 107-311
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-3510
Mailing Address - Country:US
Mailing Address - Phone:909-615-0212
Mailing Address - Fax:909-615-0212
Practice Address - Street 1:36243 INLAND VALLEY DR STE 20
Practice Address - Street 2:20
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-9547
Practice Address - Country:US
Practice Address - Phone:909-615-0212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A547430Medicaid
CAZZZ13508ZOtherBLUE SHIELD GROUP PIN
CA00A547430Medicaid