| Splinter Medical Group, Inc. | |
|
1334 W Covina Blvd #103 San Dimas CA 91773-3211 | |
| (909) 394-9090 | |
| (909) 394-9696 |
| Full Name | Splinter Medical Group, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 1334 W Covina Blvd, San Dimas, California |
| Authorized Official Name and Position | William Pevsner (PRESIDENT/PHYSICIAN) |
| Authorized Official Contact | 9093949090 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Splinter Medical Group, Inc. 1334 W Covina Blvd #103 San Dimas CA 91773-3211 Ph: (909) 394-9090 | Splinter Medical Group, Inc. 1334 W Covina Blvd #103 San Dimas CA 91773-3211 Ph: (909) 394-9090 |
| NPI Number | 1629053723 |
|---|---|
| Provider Enumeration Date | 12/12/2005 |
| Last Update Date | 05/11/2018 |
| Medicare PECOS PAC ID | 4587691258 |
|---|---|
| Medicare Enrollment ID | O20050725000563 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629053723 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 20A5383 (California) | Primary |
| Provider Name | William J Pevsner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679758171 PECOS PAC ID: 2264460518 Enrollment ID: I20050728001001 |
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