| Scintadel Liberty, Inc. | |
|
6833 Indiana Ave Ste 208 Riverside CA 92506-4223 | |
| (213) 422-6853 | |
| Not Available |
| Full Name | Scintadel Liberty, Inc. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 6833 Indiana Ave Ste 208, Riverside, California |
| Authorized Official Name and Position | Vijay Chandran (CEO) |
| Authorized Official Contact | 2134226853 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Scintadel Liberty, Inc. 921 N Milliken Ave # 1176 Ontario CA 91764-5083 Ph: (213) 422-6853 | Scintadel Liberty, Inc. 6833 Indiana Ave Ste 208 Riverside CA 92506-4223 Ph: (213) 422-6853 |
| NPI Number | 1164122800 |
|---|---|
| Provider Enumeration Date | 03/09/2023 |
| Last Update Date | 04/26/2023 |
| Medicare PECOS PAC ID | 8820452139 |
|---|---|
| Medicare Enrollment ID | O20230919003100 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164122800 | NPI | - | NPPES |
| Provider Name | Buchi S Imoohi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811137938 PECOS PAC ID: 8123299567 Enrollment ID: I20110930000052 |
| Provider Name | Oluwatoyin Monsurat Ogunjale |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326605148 PECOS PAC ID: 9537535323 Enrollment ID: I20221019001978 |
| Provider Name | Vijay Chandran |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801283692 PECOS PAC ID: 5193189405 Enrollment ID: I20240402002114 |
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