| None | |
|
17299 Cremello Way Moreno Valley CA 92555 | |
| (951) 924-5023 | |
| Not Available |
| Full Name | None |
|---|---|
| Speciality | Clinic/center - Public Health, State Or Local |
| Location | 17299 Cremello Way, Moreno Valley, California |
| Authorized Official Name and Position | Jose Carlos Chavez (NURSE PRACTITIONER) |
| Authorized Official Contact | 9519245023 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| None 17299 Cremello Way Na Moreno Valley CA 92555 Ph: (951) 924-5023 | None 17299 Cremello Way Moreno Valley CA 92555 Ph: (951) 924-5023 |
| NPI Number | 1447394531 |
|---|---|
| Provider Enumeration Date | 02/20/2007 |
| Last Update Date | 08/06/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447394531 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP0905X | Clinic/center - Public Health, State Or Local | 14641 (California) | Primary |
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