| Parkside Medical Group Inc | |
|
1310 San Bernardino Road Suite 102 Upland CA 91786-4985 | |
| (909) 608-2008 | |
| (909) 608-7705 |
| Full Name | Parkside Medical Group Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1310 San Bernardino Road, Upland, California |
| Authorized Official Name and Position | Mohsen Ibrahim Ali (OWNER) |
| Authorized Official Contact | 9096082008 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Parkside Medical Group Inc 1310 San Bernardino Road Suite 102 Upland CA 91786-4985 Ph: (909) 608-2008 | Parkside Medical Group Inc 1310 San Bernardino Road Suite 102 Upland CA 91786-4985 Ph: (909) 608-2008 |
| NPI Number | 1891935862 |
|---|---|
| Provider Enumeration Date | 03/03/2009 |
| Last Update Date | 06/18/2015 |
| Medicare PECOS PAC ID | 4385790583 |
|---|---|
| Medicare Enrollment ID | O20090912000155 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891935862 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A101427 (California) | Secondary |
| 2084N0400X | Psychiatry & Neurology - Neurology | A33406 (California) | Primary |
| Provider Name | William S Baek |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1326095977 PECOS PAC ID: 5890791529 Enrollment ID: I20061019000505 |
| Provider Name | Mohsen I Ali |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1750359071 PECOS PAC ID: 3274428545 Enrollment ID: I20081126000229 |
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