| Southern California Primary Medical Inc | |
|
19341 Bear Valley Rd Ste 101 Apple Valley CA 92308 | |
| (760) 810-7778 | |
| (760) 810-7780 |
| Full Name | Southern California Primary Medical Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 19341 Bear Valley Rd Ste 101, Apple Valley, California |
| Authorized Official Name and Position | Ashish Malhotra (OWNER) |
| Authorized Official Contact | 7608107778 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern California Primary Medical Inc 8237 Rochester Ave Ste 110 Rancho Cucamonga CA 91730-0717 Ph: (909) 477-3310 | Southern California Primary Medical Inc 19341 Bear Valley Rd Ste 101 Apple Valley CA 92308 Ph: (760) 810-7778 |
| NPI Number | 1043508559 |
|---|---|
| Provider Enumeration Date | 07/18/2011 |
| Last Update Date | 08/06/2018 |
| Medicare PECOS PAC ID | 4688843220 |
|---|---|
| Medicare Enrollment ID | O20110816000412 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043508559 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | A91216 (California) | Primary |
| 261QP2300X | Clinic/center - Primary Care | A91216 (California) | Secondary |
| Provider Name | Ashish Malhotra |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679583744 PECOS PAC ID: 4880655083 Enrollment ID: I20070726000253 |
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