Provider Demographics
NPI:1467280990
Name:ALERTIVE HEALTHCARE MEDICAL GROUP APC
Entity type:Organization
Organization Name:ALERTIVE HEALTHCARE MEDICAL GROUP APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SIVARAMAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:GOUNDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-361-0185
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:
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:951-466-6628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALERTIVE HEALTHCARE MEDICAL GROUP APC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty