Provider Demographics
NPI:1972861797
Name:CENTRAL OCCUPATIONAL MEDICINE PROVIDERS ONTARIO INC
Entity Type:Organization
Organization Name:CENTRAL OCCUPATIONAL MEDICINE PROVIDERS ONTARIO INC
Other - Org Name:COMP
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SPEER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-222-2206
Mailing Address - Street 1:4300 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2918
Mailing Address - Country:US
Mailing Address - Phone:951-222-2206
Mailing Address - Fax:951-222-2196
Practice Address - Street 1:4300 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2918
Practice Address - Country:US
Practice Address - Phone:951-222-2206
Practice Address - Fax:951-222-2196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48324207Q00000X
CAC41297207Q00000X
CA20A5982207Q00000X
CAA36269207Q00000X
CAA48512207R00000X
CAA92637207R00000X
CAG72529208D00000X
CAG70519208D00000X
CA20A9190208D00000X
261QX0100X
CAPA11255363AM0700X
CAPA52001363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty