| Pituck Medical Group, Inc. | |
|
5858 Magnolia Ave Ste C Riverside CA 92506-1886 | |
| (714) 223-0396 | |
| (714) 223-0397 |
| Full Name | Pituck Medical Group, Inc. |
|---|---|
| Speciality | Psychologist - Prescribing (medical) |
| Location | 5858 Magnolia Ave Ste C, Riverside, California |
| Authorized Official Name and Position | Michele Severson (ADMINISTRATOR) |
| Authorized Official Contact | 7142230396 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pituck Medical Group, Inc. 432 Somerset Dr Placentia CA 92870-2025 Ph: (714) 223-0396 | Pituck Medical Group, Inc. 5858 Magnolia Ave Ste C Riverside CA 92506-1886 Ph: (714) 223-0396 |
| NPI Number | 1255544557 |
|---|---|
| Provider Enumeration Date | 05/07/2007 |
| Last Update Date | 12/04/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255544557 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TP0016X | Psychologist - Prescribing (medical) | (* (Not Available)) | Primary |
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