SOUTHERN CALIFORNIA PRIMARY CARE MEDICAL GROUP, INC (NPI# 1376632281) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376632281 |
| Entity Type | Organization |
| Organization Name | SOUTHERN CALIFORNIA PRIMARY CARE MEDICAL GROUP, INC |
| Other Organization Name | CANYON LAKE URGENT & FAMILY CARE |
| Practice Address |
31581 Canyon Estates Dr Lake Elsinore CA 92532-0424 |
| Practice Telephone | 9512443500 |
| Practice Fax Number | 9512443535 |
| Mailing Telephone | 9512443500 |
| Mailing Fax Number | 9512443535 |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2013-10-22 |
| Authorized Official Name | DR. MOHAMMAD R DANESH (DIRECTOR) |
| Authorized Official Telephone | 9512443500 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QU0200X |
Clinic/Center Specialization: Urgent Care |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Canyon Lake Urgent & Family Care | Doing Business As Name - Organization |
| Street Address |
31581 CANYON ESTATES DR |
| City | LAKE ELSINORE |
| State | CA |
| Zip Code | 92532-0424 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811999261 | Mohammad Reza Danesh | Family Medicine | 31581 Canyon Estates Dr, Lake Elsinore, CA 92532-0424 | 2005-08-15 |
| 1790253672 | Navdeep Kaur Gill | Physician Assistant | 31581 Canyon Estates Dr, Lake Elsinore, CA 92532-0424 | 2018-11-08 |
| 1477074094 | Vincent Lieras | Family Medicine | 31581 Canyon Estates Dr, Lake Elsinore, CA 92532-0424 | 2017-07-05 |
| 1023483591 | Ryan Jacobs | Physician Assistant | 31581 Canyon Estates Dr, Lake Elsinore, CA 92532-0424 | 2015-12-08 |
| 1841664711 | Christina Kim Tran | Physician Assistant | 31581 Canyon Estates Dr, Lake Elsinore, CA 92532-0424 | 2015-11-16 |
| 1518377894 | Kun Saville | Physician Assistant | 31581 Canyon Estates Dr, Lake Elsinore, CA 92532-0424 | 2014-05-07 |
| 1710242474 | Southern California Primary Care Canyon Lake Urgent & Family Care | Non-Pharmacy Dispensing Site | 31581 Canyon Estates Dr, Lake Elsinore, CA 92532-0424 | 2012-07-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649817842 | The Social Work Action Group | Family Medicine | 28497 California 74 Suite 113, Lake Elsinore, CA 92532 | 2019-12-06 |
| 1720477235 | Skyler Jeffrey Liatti | Dentist | 29273 Central Ave Ste A, Lake Elsinore, CA 92532 | 2015-01-21 |
| 1386068310 | Michael D Boucher | Physician Assistant | 29997 Canyon Hills Rd Ste 1604, Lake Elsinore, CA 92532 | 2014-02-11 |
| 1902083595 | Joong Gu Han | Acupuncturist | 53116 Tropical Street, Lake Elsinore, CA 92532 | 2008-01-25 |
| 1063632123 | Taba Apostu & Apostu Professional Dental Corp | Dentist | 361 Railroad Canyon Rd, #a, Lake Elsinore, CA 92532 | 2007-04-30 |
| 1164584793 | Stephen Gerard Schroeder | Optometrist | 25321 Railroad Canyon Dr., #503, Lake Elsinore, CA 92532 | 2006-12-13 |
| 1194821041 | Derek B. Hauser | Dentist | 31571 Canyon Estates Dr Ste 117, Lake Elsinore, CA 92532 | 2006-09-16 |
| 1912017567 | Costco Wholesale Corporation | Pharmacy | 29315 Central Ave, Lake Elsinore, CA 92532 | 2006-08-30 |
| 1952331217 | Longs Drug Stores California LLC | Durable Medical Equipment & Medical Supplies | 29985 Canyon Hills Road, Lake Elsinore, CA 92532 | 2006-07-03 |
| 1467709642 | Matthew Randall Kanter | Dentist | 31571 Canyon Estates Dr Ste 117, Lake Elsinore, CA 92532 | 2012-08-07 |
| Find all providers in zip 92532 | ||||
| Taxonomy Code | 261QU0200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Urgent Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659815256 | A Plus Walk-in Urgent Care Medical Clinic, Apc | Clinic/Center | 31571 Canyon Estates Dr, Suite 100, Lake Elsinore, CA 92532-0468 | 2016-12-15 |
| 1003286253 | Inland Urgent Care A Medical Corporation | Clinic/Center | 29997 Canyon Hills Rd Ste 1604, Lake Elsinore, CA 92532-2581 | 2015-09-30 |
| 1992950703 | Total Care Family Medical Center of Lake Elsinore, Inc. | Clinic/Center | 425 Diamond Drive, Suite 105, Lake Elsinore, CA 92530 | 2008-11-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417556440 | Cottage Clinical Network LLC | Clinic/Center | 7070 Hollister Ave Ste 103, Goleta, CA 93117-2895 | 2020-10-21 |
| 1780291047 | Ultra Urgent Care | Clinic/Center | 2875 W 7th St, Los Angeles, CA 90005-3907 | 2020-09-30 |
| 1780291351 | Care Now Urgentcare | Clinic/Center | 5236 Palm Ave, Whittier, CA 90601-2210 | 2020-09-28 |
| 1811503519 | We Care Urgent Care LLC | Clinic/Center | 11177 Tampa Ave Unit A, Northridge, CA 91326-2254 | 2020-09-17 |
| 1114531035 | Q & M Physician Assistant Corporation | Clinic/Center | 941 Kendall Dr Ste C, San Bernardino, CA 92407-4156 | 2020-09-08 |
| 1568070662 | Atlas Urgent Care Corporation | Clinic/Center | 5531 Business Park S, Bakersfield, CA 93309-1668 | 2020-07-15 |
| 1952927378 | Anaheim Urgent Care, Inc. | Clinic/Center | 28900 S. Western Ave, Ranchos Palos Verdes, CA 90275 | 2020-06-22 |
| 1932724507 | Cottage Clinical Network, LLC | Clinic/Center | 1606 E Clark Ave, Building C, Suite 2, Orcutt, CA 93455 | 2020-06-10 |
| 1124643911 | Cottage Clinical Network, LLC | Clinic/Center | 3970 Broad St, San Luis Obispo, CA 93401-7097 | 2020-06-08 |
| 1861017659 | Cottage Clinical Network, LLC | Clinic/Center | 777 E Foothill Blvd # 777a775b, San Luis Obispo, CA 93405-1617 | 2020-06-08 |
| Find all providers with the same taxonomy | ||||
| City | LAKE ELSINORE |
| Zip Code | 92532 |
Please comment or provide details below to improve the information on SOUTHERN CALIFORNIA PRIMARY CARE MEDICAL GROUP, INC.
| 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.