Southern California Physician Network, Inc | |
2250 S Main St Ste 201 Corona CA 92882-2536 | |
(951) 621-3232 | |
(951) 882-6967 |
Full Name | Southern California Physician Network, Inc |
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Speciality | Internal Medicine |
Location | 2250 S Main St Ste 201, Corona, California |
Authorized Official Name and Position | Michael Nduati (PRESIDENT) |
Authorized Official Contact | 9512007385 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Southern California Physician Network, Inc Po Box 3046 Malvern PA 19355-0746 Ph: () - | Southern California Physician Network, Inc 2250 S Main St Ste 201 Corona CA 92882-2536 Ph: (951) 621-3232 |
NPI Number | 1083002075 |
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Provider Enumeration Date | 12/30/2014 |
Last Update Date | 05/17/2024 |
Medicare PECOS PAC ID | 4880910405 |
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Medicare Enrollment ID | O20150225002491 |
Identifier | Type | State | Issuer |
---|---|---|---|
1083002075 | NPI | - | NPPES |
CA307699 | Other | CA | MEDICARE PIN |
1083002075 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Provider Name | Joshua Leichman |
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Provider Type | Practitioner - Cardiac Electrophysiology |
Provider Identifiers | NPI Number: 1205864865 PECOS PAC ID: 5294859989 Enrollment ID: I20180724001516 |
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