| Heacock Health Medical Group, Inc. | |
|
24060 Fir Ave Ste A Moreno Valley CA 92553-2895 | |
| (951) 247-8005 | |
| (951) 247-8007 |
| Full Name | Heacock Health Medical Group, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 24060 Fir Ave Ste A, Moreno Valley, California |
| Authorized Official Name and Position | Rafael Penunuri (MEDICAL DIRECTOR) |
| Authorized Official Contact | 9512478005 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Heacock Health Medical Group, Inc. 24060 Fir Ave Ste A Moreno Valley CA 92553-2895 Ph: (951) 247-8005 | Heacock Health Medical Group, Inc. 24060 Fir Ave Ste A Moreno Valley CA 92553-2895 Ph: (951) 247-8005 |
| NPI Number | 1891251849 |
|---|---|
| Provider Enumeration Date | 02/14/2019 |
| Last Update Date | 04/15/2025 |
| Medicare PECOS PAC ID | 1456691450 |
|---|---|
| Medicare Enrollment ID | O20190328001215 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891251849 | NPI | - | NPPES |
| 1760896336 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QU0200X | Clinic/center - Urgent Care | (* (Not Available)) | Primary |
| Provider Name | Rafael Penunuri |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831270362 PECOS PAC ID: 1759432396 Enrollment ID: I20090622000595 |
County Of Riverside Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 26520 Cactus Ave, Moreno Valley, CA 92555 Phone: 951-486-4000 Fax: 951-486-4435 | |
Antonio A. Tan, Md, Professional Corporation Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 12980 Frederick St, Suite D, Moreno Valley, CA 92553 Phone: 951-485-2744 Fax: 951-485-2749 | |
Dong S. Kim, M.d., Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 11441 Heacock St, Ste. F, Moreno Valley, CA 92557 Phone: 951-243-8000 Fax: 951-243-9707 | |
Planned Parenthood Pacific Southwest Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 12900 Frederick St Ste C, Moreno Valley, CA 92553 Phone: 951-222-3101 | |
Joel A Pengson, Md, A Medical Corporation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 23180 Hemlock Ave, Moreno Valley, CA 92557 Phone: 951-243-6460 | |
John Liquete Md Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 14114 Business Center Dr, Suite D, Moreno Valley, CA 92553 Phone: 951-697-1150 | |
Yogendra B Patel,md,inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 12980 Frederick St, Suite J, Moreno Valley, CA 92553 Phone: 951-924-9300 Fax: 951-485-0240 |