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3811 Bedford Canyon Rd. Suite 104 Corona CA 92883-4465 | |
| (951) 444-0467 | |
| (951) 582-4758 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 3811 Bedford Canyon Rd., Corona, California |
| Authorized Official Name and Position | Anabelle Myers (CEO) |
| Authorized Official Contact | 9514440467 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3811 Bedford Canyon Rd. Suite 104 Corona CA 92883-4465 Ph: (951) 444-0467 | 3811 Bedford Canyon Rd. Suite 104 Corona CA 92883-4465 Ph: (951) 444-0467 |
| NPI Number | 1528564002 |
|---|---|
| Provider Enumeration Date | 04/03/2018 |
| Last Update Date | 11/15/2024 |
| Medicare PECOS PAC ID | 7214343185 |
|---|---|
| Medicare Enrollment ID | O20210302000549 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528564002 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| 291U00000X | Clinical Medical Laboratory | (* (Not Available)) | Secondary |
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