| Innovative Care Medicine | |
|
818 Magnolia Ave Ste 201 Corona CA 92879-3128 | |
| (951) 356-9992 | |
| (951) 595-4916 |
| Full Name | Innovative Care Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 818 Magnolia Ave Ste 201, Corona, California |
| Authorized Official Name and Position | Sameer Ohri (PRESIDENT/CEO) |
| Authorized Official Contact | 9513569992 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovative Care Medicine 818 Magnolia Ave Ste 201 Corona CA 92879-3128 Ph: (951) 356-9992 | Innovative Care Medicine 818 Magnolia Ave Ste 201 Corona CA 92879-3128 Ph: (951) 356-9992 |
| NPI Number | 1932591724 |
|---|---|
| Provider Enumeration Date | 03/03/2015 |
| Last Update Date | 10/24/2024 |
| Medicare PECOS PAC ID | 1052632858 |
|---|---|
| Medicare Enrollment ID | O20150604002830 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932591724 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A105886 (California) | Primary |
| Provider Name | Sameer Ohri |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669669339 PECOS PAC ID: 1850446634 Enrollment ID: I20090831000314 |
| Provider Name | Hawanatu Fofanah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831561448 PECOS PAC ID: 1456657774 Enrollment ID: I20160314001160 |
| Provider Name | Cristina Gonzales Pajarillaga-encello |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417511650 PECOS PAC ID: 9931536372 Enrollment ID: I20200225002397 |
| Provider Name | Sonia Brooks Torregano |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447854716 PECOS PAC ID: 3375950744 Enrollment ID: I20210331001581 |
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