| Canyon Springs Medical Group, Inc. | |
|
26520 Cactus Ave Rm B2018 Moreno Valley CA 92555-3927 | |
| (951) 486-5610 | |
| (951) 486-5620 |
| Full Name | Canyon Springs Medical Group, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 26520 Cactus Ave Rm B2018, Moreno Valley, California |
| Authorized Official Name and Position | Faheem M. Jukaku (PRESIDENT) |
| Authorized Official Contact | 9514865610 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Canyon Springs Medical Group, Inc. 26520 Cactus Ave Moreno Valley CA 92555-3927 Ph: (951) 486-5610 | Canyon Springs Medical Group, Inc. 26520 Cactus Ave Rm B2018 Moreno Valley CA 92555-3927 Ph: (951) 486-5610 |
| NPI Number | 1073669404 |
|---|---|
| Provider Enumeration Date | 01/26/2007 |
| Last Update Date | 04/23/2018 |
| Medicare PECOS PAC ID | 0446297634 |
|---|---|
| Medicare Enrollment ID | O20050408000993 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073669404 | NPI | - | NPPES |
| GR0088740 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | John F Randolph |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750389482 PECOS PAC ID: 6305805557 Enrollment ID: I20041213000260 |
| Provider Name | Adolfo Aguilera |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477609808 PECOS PAC ID: 1658318837 Enrollment ID: I20050408000968 |
| Provider Name | Faheem Mohammed Jukaku |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518072230 PECOS PAC ID: 9931146784 Enrollment ID: I20050413000258 |
| Provider Name | Barbara C Ackerman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1639126410 PECOS PAC ID: 4082626056 Enrollment ID: I20060613000224 |
| Provider Name | Jairo Lopez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669666186 PECOS PAC ID: 4385836048 Enrollment ID: I20101013000436 |
| Provider Name | Yuliana Soe |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235450594 PECOS PAC ID: 0042446544 Enrollment ID: I20131111000756 |
| Provider Name | Nathan D Mclaughlin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104069889 PECOS PAC ID: 0547412843 Enrollment ID: I20131227000587 |
| Provider Name | Wael Hamade |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295924710 PECOS PAC ID: 7113094723 Enrollment ID: I20160818000947 |
| Provider Name | Shunling Tsang |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497052443 PECOS PAC ID: 4880989318 Enrollment ID: I20160823002731 |
| Provider Name | Parastou Farhadian |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538496419 PECOS PAC ID: 8224323621 Enrollment ID: I20160824001987 |
| Provider Name | Brenda Jerez-aguilar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972052132 PECOS PAC ID: 3779868443 Enrollment ID: I20170320001371 |
| Provider Name | Uziel Sauceda |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164837191 PECOS PAC ID: 3870873532 Enrollment ID: I20170726003564 |
| Provider Name | Amar Dave |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336588623 PECOS PAC ID: 8921368887 Enrollment ID: I20180214001464 |
| Provider Name | Jin Seon Kim Paglingayen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699152819 PECOS PAC ID: 6507112786 Enrollment ID: I20180629002001 |
| Provider Name | Esther N Zarecki |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326570540 PECOS PAC ID: 9638411796 Enrollment ID: I20190422001630 |
| Provider Name | Heidi Pang |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790213494 PECOS PAC ID: 7214358621 Enrollment ID: I20200610001296 |
| Provider Name | Vivian Yang |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639604523 PECOS PAC ID: 0345661781 Enrollment ID: I20200610002638 |
| Provider Name | Jennifer Ann Vazquez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841873486 PECOS PAC ID: 1759781321 Enrollment ID: I20210618000810 |
| Provider Name | Sarah Duan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124687645 PECOS PAC ID: 0749656346 Enrollment ID: I20221024001303 |
| Provider Name | Ivy H Vu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003545641 PECOS PAC ID: 4688094758 Enrollment ID: I20230322001933 |
Riverside University Health System Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 26520 Cactus Ave, Moreno Valley, CA 92555 Phone: 951-486-4000 Fax: 951-486-4435 | |
Antonio A. Tan, Md, Professional Corporation Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 12980 Frederick St, Suite D, Moreno Valley, CA 92553 Phone: 951-485-2744 Fax: 951-485-2749 | |
Dong S. Kim, M.d., Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 11441 Heacock St, Ste. F, Moreno Valley, CA 92557 Phone: 951-243-8000 Fax: 951-243-9707 | |
Planned Parenthood Pacific Southwest Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 12900 Frederick St Ste C, Moreno Valley, CA 92553 Phone: 951-222-3101 | |
Joel A Pengson, Md, A Medical Corporation Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 23180 Hemlock Ave, Moreno Valley, CA 92557 Phone: 951-243-6460 | |
John Liquete Md Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 14114 Business Center Dr, Suite D, Moreno Valley, CA 92553 Phone: 951-697-1150 | |
Yogendra B Patel,md,inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 12980 Frederick St, Suite J, Moreno Valley, CA 92553 Phone: 951-924-9300 Fax: 951-485-0240 |