CANYON SPRINGS MEDICAL GROUP, INC. (NPI# 1073669404) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073669404 |
| Entity Type | Organization |
| Organization Name | CANYON SPRINGS MEDICAL GROUP, INC. |
| Practice Address |
26520 Cactus Ave Rm B2018 Moreno Valley CA 92555-3927 |
| Mailing Address |
26520 Cactus Ave Moreno Valley CA 92555-3927 |
| Practice Telephone | 9514865610 |
| Practice Fax Number | 9514865620 |
| Mailing Telephone | 9514865610 |
| Mailing Fax Number | 9514865620 |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2018-04-23 |
| Authorized Official Name | FAHEEM M. JUKAKU (PRESIDENT) |
| Authorized Official Telephone | 9514865610 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | GR0088740 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 26520 Cactus Ave Rm B2018, Moreno Valley, CA 925553927 | 9514865610 | 9514865620 |
| Street Address |
26520 CACTUS AVE RM B2018 |
| City | MORENO VALLEY |
| State | CA |
| Zip Code | 92555-3927 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730665795 | Laura King | Student in an Organized Health Care Education/Training Program | 26520 Cactus Ave Rm B2018, Moreno Valley, CA 92555-3927 | 2018-07-12 |
| 1528554656 | Hiren Swami | Student in an Organized Health Care Education/Training Program | 26520 Cactus Ave Rm B2018, Moreno Valley, CA 92555-3927 | 2018-07-01 |
| 1982197901 | Mahtab Moshtagh Sisan | Student in an Organized Health Care Education/Training Program | 26520 Cactus Ave Rm B2018, Moreno Valley, CA 92555-3927 | 2018-06-13 |
| 1699268615 | Gulraiz Matlub | Student in an Organized Health Care Education/Training Program | 26520 Cactus Ave Rm B2018, Moreno Valley, CA 92555-3927 | 2018-06-13 |
| 1952894891 | Zahra Sherazi | Student in an Organized Health Care Education/Training Program | 26520 Cactus Ave Rm B2018, Moreno Valley, CA 92555 | 2018-06-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043817935 | Jillian Mika Ogata | Social Worker | Riverside University Health System, 26520 Cactus Ave., Moreno Valley, CA 92555 | 2020-10-05 |
| 1114549144 | Providence Recovery Centers, Inc. | Substance Abuse Rehabilitation Facility | 11165 Bonnie View Ave, Moreno Valley, CA 92555 | 2020-05-13 |
| 1720645096 | Shahida Nawaz | Non-emergency Medical Transport (VAN) | 26528 Primrose Way, Moreno Valley, CA 92555 | 2019-05-22 |
| 1679139828 | Moses Lee | Student in an Organized Health Care Education/Training Program | Department of Orthopaedic Surgery Rm. B2042 Ruhs-mc, 26520 Cactus Ave., Moreno Valley, CA 92555 | 2019-05-14 |
| 1215419668 | Johannes Wattimena | Counselor | 26624 Saffron Circle, Moreno Valley, CA 92555 | 2018-09-02 |
| 1437676939 | Aleksandra Vargas | Behavioral Analyst | 12549 Atherton Dr, Moreno Valley, CA 92555 | 2017-08-25 |
| 1063938603 | Anthony I Odimegwu | Nurse Practitioner | 26062 Bercaw Ct, Moreno Valley, CA 92555 | 2017-08-16 |
| 1073036703 | Karen Parker | Licensed Psychiatric Technician | 12944 Dolomite Lane, Moreno Valley, CA 92555 | 2017-07-25 |
| 1861923674 | Elena Vizcaino | Behavior Technician | 15670 Turnberry St, Moreno Valley, CA 92555 | 2017-03-23 |
| 1154744522 | Nancy Chivichon | Dietitian, Registered | 28648 Avenue Ave., Moreno Valley, CA 92555 | 2014-01-21 |
| Find all providers in zip 92555 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932746310 | Nextgen Medical Services Inc | Family Medicine | 24060 Fir Ave Ste A-1, Moreno Valley, CA 92553-2895 | 2019-12-05 |
| 1922582592 | Clinica Medica Latina, Inc | Family Medicine | 24805 Alessandro Blvd Ste 8, Moreno Valley, CA 92553-6101 | 2018-09-19 |
| 1386132041 | Remedial Medical Group | Family Medicine | 12730 Heacock St Ste 4a, Moreno Valley, CA 92553-3040 | 2018-04-27 |
| 1174988935 | Hamed Shalikar | Family Medicine | 22721 Tea Rose Ln, Moreno Valley, CA 92557-6016 | 2015-12-22 |
| 1881941409 | Alessandro Medical Professional Corporation | Family Medicine | 13925 Indian St, Moreno Valley, CA 92553-5718 | 2012-08-14 |
| 1619279213 | Aik Gazarian | Family Medicine | 26502 Cactus Ave, B2017, Moreno Valley, CA 92555 | 2010-12-02 |
| 1841524824 | Mahbuba Khan | Family Medicine | 17149 Via Xavier, Moreno Valley, CA 92555-3339 | 2009-09-24 |
| 1740423128 | Suzette Lee Jumamil | Family Medicine | 12959 Dolomite Ln, Moreno Valley, CA 92555-4514 | 2009-04-14 |
| 1104069889 | Nathan Mclaughlin | Family Medicine | 23520 Cactus Ave, Moreno Valley, CA 92553-8906 | 2009-04-11 |
| 1952485641 | Valenzuela Medical Group I, Inc. | Family Medicine | 24226 Sunnymead Blvd, Moreno Valley, CA 92553-7739 | 2006-10-25 |
| Find all providers in MORENO VALLEY | ||||
| City | MORENO VALLEY |
| Zip Code | 92555 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.