KISHORE K VASANT MEDICAL GROUP INC. (NPI# 1518993484) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518993484 |
| Entity Type | Organization |
| Organization Name | KISHORE K VASANT MEDICAL GROUP INC. |
| Practice Address |
36450 Inland Valley Dr Suite # 116 Wildomar CA 92595-9583 |
| Practice Telephone | 9516988876 |
| Practice Fax Number | 9516985560 |
| Mailing Telephone | 9516988876 |
| Mailing Fax Number | 9516985560 |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. KISHORE K VASANT (CEO) |
| Authorized Official Telephone | 9516988876 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | A33638 | CA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 00A336380 | 05 |
| Street Address |
36450 INLAND VALLEY DR SUITE # 116 |
| City | WILDOMAR |
| State | CA |
| Zip Code | 92595-9583 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568901833 | Pamela Warmington | Pharmacist | 36450 Inland Valley Dr, Suite 209, Wildomar, CA 92595-9583 | 2017-02-19 |
| 1407395866 | Jeffrey Labandelo Fajardo | Pharmacist | 36450 Inland Valley Dr, Wildomar, CA 92595-9583 | 2017-02-18 |
| 1114466653 | Bassam Azzam | Pharmacist | 36450 Inland Valley Dr, Wildomar, CA 92595 | 2017-02-16 |
| 1386182285 | Dante Gibson | Pharmacist | 36450 Inland Valley Dr, Suite #209, Wildomar, CA 92595-9583 | 2017-02-10 |
| 1912445818 | David Chen | Pharmacist | 36450 Inland Valley Dr, Wildomar, CA 92595-9583 | 2017-02-10 |
| 1245614502 | Yalda Lynn Howard | Pharmacist | 36450 Inland Valley Dr, Wildomar, CA 92595-9583 | 2015-07-16 |
| 1144614447 | Kevin Suresh Chandrasena | Internal Medicine | 36450 Inland Valley Dr, Wildomar, CA 92595 | 2015-03-25 |
| 1023406675 | Sarah Devine-cooter | Registered Nurse | 36450 Inland Valley Dr, Wildomar, CA 92595-9583 | 2015-01-06 |
| 1841617875 | Frank Joseph Mercardante Jr. | Pediatrics | 36450 Inland Valley Dr, Wildomar, CA 92595-9583 | 2014-03-27 |
| 1205193521 | Noel Nepomuceno Jr. | Family Medicine | 36450 Inland Valley Dr, Southern California Permanente Medical Group, Wildomar, CA 92595-9583 | 2012-04-12 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184190845 | Amber Nicole Salgado | Licensed Vocational Nurse | 33685 Harvest Way East, Wildomar, CA 92595 | 2018-10-22 |
| 1417448168 | Inland Valley Trauma and Acute Care Surgery Apc Inc | Surgery | 36320 Inland Valley Dr Ste 101a, Wildomar, CA 92595 | 2018-05-29 |
| 1033636311 | Omar H Nael | Behavioral Analyst | 35925 Susan Dr, Wildomar, CA 92595 | 2017-08-27 |
| 1023535820 | Dennis Bonavilla | Specialist/Technologist, Other | 34859 Frederick Street, Suite 112, Wildomar, CA 92595 | 2017-08-23 |
| 1578965901 | Purnima K Patel M.d Inc | Internal Medicine | 32423 Inland Valley Dr. Ste 160, Wildomar, CA 92595 | 2014-09-17 |
| 1740523133 | Jerry Zhong Yu | Internal Medicine | 36320 Inland Valley Dr Ste 308, Wildomar, CA 92595 | 2013-04-03 |
| 1871859553 | Norman Orr | Internal Medicine | 36485 Valley Medical Center, Wildomar, CA 92595 | 2012-04-06 |
| 1902190226 | Brian Patrick Tiu | Surgery | 36320 Inland Valley Dr Ste 101, Wildomar, CA 92595 | 2011-06-03 |
| 1508013897 | Lifecare Solutions Inc | Durable Medical Equipment & Medical Supplies | 24335 Prielipp Rd Bldg A, Ste 116, Wildomar, CA 92595 | 2008-08-19 |
| 1760604383 | Nasko Lubenov Atanassov | Physical Therapist | 36485 Inland Valey Drive, Wildomar, CA 92595 | 2007-05-03 |
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| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235431172 | Inscriptions Children's Clinic | Clinic/Center | 36243 Inland Valley Dr, Suite #80, Wildomar, CA 92595-9549 | 2010-11-29 |
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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.