Provider Demographics
NPI:1831408061
Name:MULTISPECIALITY AND OCCUPATIONAL INJURY MEDICAL CENTER A MED CORP
Entity type:Organization
Organization Name:MULTISPECIALITY AND OCCUPATIONAL INJURY MEDICAL CENTER A MED CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/BILLER
Authorized Official - Prefix:
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-340-2178
Mailing Address - Street 1:703 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3118
Mailing Address - Country:US
Mailing Address - Phone:951-340-2178
Mailing Address - Fax:951-340-2478
Practice Address - Street 1:703 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3118
Practice Address - Country:US
Practice Address - Phone:951-340-2178
Practice Address - Fax:951-340-2478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-06
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70230207R00000X
CAA68736207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A687360Medicaid
H21160Medicare UPIN