Provider Demographics
NPI:1467024331
Name:ALERTIVE HEALTHCARE MEDICAL GROUP APC
Entity type:Organization
Organization Name:ALERTIVE HEALTHCARE MEDICAL GROUP APC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SIVARAMAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:GOUNDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-762-2485
Mailing Address - Street 1:32605 TEMECULA PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-6839
Mailing Address - Country:US
Mailing Address - Phone:206-445-9978
Mailing Address - Fax:
Practice Address - Street 1:4500 BROCKTON AVE STE 305
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4027
Practice Address - Country:US
Practice Address - Phone:206-445-9978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty