TOTAL CARE FAMILY MEDICAL CENTER OF LAKE ELSINORE INC (NPI# 1639594955) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639594955 |
| Entity Type | Organization |
| Organization Name | TOTAL CARE FAMILY MEDICAL CENTER OF LAKE ELSINORE INC |
| Other Organization Name | TOTAL CARE FAMILY MEDICAL CENTER |
| Practice Address |
425 Diamond Dr Suite 102 Lake Elsinore CA 92530-4495 |
| Mailing Address |
5626 Oberlin Dr Suite 110 San Diego CA 92121-1705 |
| Practice Telephone | 9516748779 |
| Enumeration Date | 2014-02-24 |
| Last Update Date | 2014-02-24 |
| Authorized Official Name | KENNY HEINE (VP OF OPERATIONS) |
| Authorized Official Telephone | 8589641506 |
| Is Organization Subpart | Y |
| Parent Organization Name | MEDVANTX, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332900000X | Non-Pharmacy Dispensing Site | 72993 | CA | Suppliers |
| Other Name | Type Code |
|---|---|
| Total Care Family Medical Center | Doing Business As Name - Organization |
| Street Address |
425 DIAMOND DR SUITE 102 |
| City | LAKE ELSINORE |
| State | CA |
| Zip Code | 92530-4495 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396737110 | Peggy Elizabeth Dixon Mcgill | Nurse Practitioner | 425 Diamond Dr, Lake Elsinore, CA 92530-4495 | 2005-08-17 |
| 1497216824 | Megan Renee Hall | Physician Assistant | 425 Diamond Dr, Lake Elsinore, CA 92530-4495 | 2019-03-28 |
| 1942747951 | Rochelle Bui | Physician Assistant | 425 Diamond Dr, Suite #105, Lake Elsinore, CA 92530-4495 | 2017-01-28 |
| 1932524501 | Roslyn Richardson | Nurse Practitioner | 425 Diamond Dr, Lake Elsinore, CA 92530-4495 | 2014-02-19 |
| 1497069660 | William M. Kelly M.d., Inc. | Radiology | 425 Diamond Dr, Suite 103, Lake Elsinore, CA 92530-4495 | 2010-07-30 |
| 1538499470 | Shafi Ullah Siddiqi | General Practice | 425 Diamond Dr, Ste 102, Lake Elsinore, CA 92530-4495 | 2009-12-27 |
| 1679737795 | Linda Marie Evans | Physical Therapist | 425 Diamond Dr, Ste. 101, Lake Elsinore, CA 92530-4495 | 2008-07-17 |
| 1700059995 | Farid Saadat Md Inc | Internal Medicine | 425 Diamond Dr, Suite 102, Lake Elsinore, CA 92530-4561 | 2008-04-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841801479 | Mercedes Samantha Hamilton | Licensed Psychiatric Technician | 18465 Grand Ave, Lake Elsinore, CA 92530 | 2020-08-17 |
| 1700423779 | Karrene Louise Stanard | Peer Specialist | 31764 Casino Drive, Suite 300, Lake Elsinore, CA 92530 | 2019-12-09 |
| 1972149961 | Danielle Cravalho | Student in an Organized Health Care Education/Training Program | 31964 Mission Trail, Suite B, Lake Elsinore, CA 92530 | 2019-11-25 |
| 1952825648 | R.e. Levi Dental Corporation | Dentist | 32235 Mission Trail # 8, Lake Elsinore, CA 92530 | 2017-08-03 |
| 1144760729 | Alfred Metwashla | Pharmacist | 18269 Collier Ave, Lake Elsinore, CA 92530 | 2017-03-02 |
| 1750788733 | Roxanne Martinez | Case Manager/Care Coordinator | 31764 Casino Drive, Lake Elsinore, CA 92530 | 2014-11-19 |
| 1871870907 | Bryan Tuan Tran | Pharmacist | 160 Diamond Drive, Lake Elsinore, CA 92530 | 2011-11-03 |
| 1043590821 | Katherynn Elizabeth Williams | Marriage & Family Therapist | 600 Central Ave Ste 201, Lake Elsinore, CA 92530 | 2011-08-24 |
| 1861771677 | Judy Kelly | Marriage & Family Therapist | 224 West Graham Ave, Lake Elsinore, CA 92530 | 2011-08-10 |
| 1427343813 | Patrick Chern | Pharmacist | 18287 Collier Ave., Lake Elsinore, CA 92530 | 2011-06-14 |
| Find all providers in zip 92530 | ||||
| Taxonomy Code | 332900000X |
| Grouping | Suppliers |
| Classification | Non-Pharmacy Dispensing Site |
| A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
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| 1174032353 | Golden Gate Urology, Inc. | Non-Pharmacy Dispensing Site | 139 Townsend St Ste 100, San Francisco, CA 94107-1946 | 2017-09-20 |
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| Find all providers with the same taxonomy | ||||
| City | LAKE ELSINORE |
| Zip Code | 92530 |
Please comment or provide details below to improve the information on TOTAL CARE FAMILY MEDICAL CENTER OF LAKE ELSINORE 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.