| Reform | |
|
33562 Yucaipa Blvd # 4-413 Yucaipa CA 92399-2072 | |
| (909) 583-1520 | |
| Not Available |
| Full Name | Reform |
|---|---|
| Speciality | Clinic/Center |
| Location | 33562 Yucaipa Blvd # 4-413, Yucaipa, California |
| Authorized Official Name and Position | Megan Lynnell Anderson (PRESIDENT) |
| Authorized Official Contact | 9095831520 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Reform 33562 Yucaipa Blvd # 4-413 Yucaipa CA 92399-2072 Ph: (909) 583-1520 | Reform 33562 Yucaipa Blvd # 4-413 Yucaipa CA 92399-2072 Ph: (909) 583-1520 |
| NPI Number | 1962238022 |
|---|---|
| Provider Enumeration Date | 09/13/2024 |
| Last Update Date | 10/28/2024 |
| Certification Date | 10/28/2024 |
| Medicare PECOS PAC ID | 7618400698 |
|---|---|
| Medicare Enrollment ID | O20241029003672 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962238022 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | () | Primary |
| Provider Name | Megan Lynnell Anderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528442977 PECOS PAC ID: 1456667005 Enrollment ID: I20150827003012 |
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