Provider Demographics
NPI:1851433502
Name:TRI-INDUSTRIAL MEDICAL CENTER
Entity Type:Organization
Organization Name:TRI-INDUSTRIAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-360-8333
Mailing Address - Street 1:10427 SAN SEVAINE WAY STE J
Mailing Address - Street 2:
Mailing Address - City:MIRA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91752-1151
Mailing Address - Country:US
Mailing Address - Phone:951-360-8333
Mailing Address - Fax:951-360-1401
Practice Address - Street 1:10427 SAN SEVAINE WAY STE J
Practice Address - Street 2:
Practice Address - City:MIRA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91752-1151
Practice Address - Country:US
Practice Address - Phone:951-360-8333
Practice Address - Fax:951-360-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA037286261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1205943354OtherNPI
CAD34067Medicare UPIN