| Poom Medical Clinic Inc | |
|
2055 N Perris Blvd Ste E6 Perris CA 92571-2517 | |
| (951) 940-4176 | |
| (951) 940-4038 |
| Full Name | Poom Medical Clinic Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 2055 N Perris Blvd Ste E6, Perris, California |
| Authorized Official Name and Position | Lida Poommipanit-bajon (SECRETARY) |
| Authorized Official Contact | 8084191187 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Poom Medical Clinic Inc 16293 Regency Ranch Rd Riverside CA 92504-5654 Ph: (808) 419-1187 | Poom Medical Clinic Inc 2055 N Perris Blvd Ste E6 Perris CA 92571-2517 Ph: (951) 940-4176 |
| NPI Number | 1831548197 |
|---|---|
| Provider Enumeration Date | 06/08/2016 |
| Last Update Date | 06/08/2016 |
| Medicare PECOS PAC ID | 0042506834 |
|---|---|
| Medicare Enrollment ID | O20160902000841 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831548197 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A 70122 (California) | Primary |
| Provider Name | Lida B Poommipanit-bajon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861563413 PECOS PAC ID: 6901897727 Enrollment ID: I20040520000979 |
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