| Jason Michael Bradley Couture, Md Inc. | |
|
6848 Magnolia Ave Suite 230 Riverside CA 92506-2857 | |
| (951) 682-9911 | |
| (909) 825-1868 |
| Full Name | Jason Michael Bradley Couture, Md Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 6848 Magnolia Ave, Riverside, California |
| Authorized Official Name and Position | Jason M. Couture (OWNER/CEO) |
| Authorized Official Contact | 9098513847 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jason Michael Bradley Couture, Md Inc. 6848 Magnolia Ave Suite 230 Riverside CA 92506-2857 Ph: (951) 682-9911 | Jason Michael Bradley Couture, Md Inc. 6848 Magnolia Ave Suite 230 Riverside CA 92506-2857 Ph: (951) 682-9911 |
| NPI Number | 1760610315 |
|---|---|
| Provider Enumeration Date | 06/22/2009 |
| Last Update Date | 06/22/2009 |
| Medicare PECOS PAC ID | 2365618055 |
|---|---|
| Medicare Enrollment ID | O20111230000071 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760610315 | NPI | - | NPPES |
| A100590 | Other | CA | STATE MEDICAL LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A100590 (California) | Primary |
| Provider Name | Jason M Couture |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962609115 PECOS PAC ID: 8325214018 Enrollment ID: I20111230000149 |
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