| Desouza Medical Group Inc | |
|
26321 Santiago Canyon Road Corona CA 92883 | |
| (877) 258-6331 | |
| (718) 362-1651 |
| Full Name | Desouza Medical Group Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 26321 Santiago Canyon Road, Corona, California |
| Authorized Official Name and Position | Lienio De Souza (OWNER PROVIDER) |
| Authorized Official Contact | 9519778845 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Desouza Medical Group Inc 26321 Santiago Canyon Rd Corona CA 92883-5229 Ph: (877) 258-6331 | Desouza Medical Group Inc 26321 Santiago Canyon Road Corona CA 92883 Ph: (877) 258-6331 |
| NPI Number | 1386409704 |
|---|---|
| Provider Enumeration Date | 02/15/2024 |
| Last Update Date | 10/24/2024 |
| Medicare PECOS PAC ID | 9335585983 |
|---|---|
| Medicare Enrollment ID | O20240306001917 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386409704 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Lienio Ferreira De Souza |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467989269 PECOS PAC ID: 3476941964 Enrollment ID: I20240306002533 |
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