SOUTHERN CALIFORNIA PRIMARY CARE CANYON LAKE URGENT & FAMILY CARE (NPI# 1710242474) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710242474 |
| Entity Type | Organization |
| Organization Name | SOUTHERN CALIFORNIA PRIMARY CARE CANYON LAKE URGENT & FAMILY CARE |
| Other Organization Name | DANESH MEDICAL GROUP |
| Practice Address |
31581 Canyon Estates Dr Lake Elsinore CA 92532-0424 |
| Mailing Address |
5626 Oberlin Dr Suite 110 San Diego CA 92121-1705 |
| Practice Telephone | 9512443500 |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2012-10-25 |
| Authorized Official Name | KENNY HEINE (VP OPS) |
| 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 | A48943 | CA | Suppliers |
| Other Name | Type Code |
|---|---|
| DANESH MEDICAL GROUP | 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 |
| 1376632281 | Southern California Primary Care Medical Group, Inc | Clinic/Center | 31581 Canyon Estates Dr, Lake Elsinore, CA 92532-0424 | 2006-10-11 |
| 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 | 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 |
|---|---|---|---|---|
| 1639594955 | Total Care Family Medical Center of Lake Elsinore Inc | Non-Pharmacy Dispensing Site | 425 Diamond Dr, Suite 102, Lake Elsinore, CA 92530-4495 | 2014-02-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982225496 | Artius Dermatology Associates PC | Non-Pharmacy Dispensing Site | 5757 Pacific Ave Ste 228, Stockton, CA 95207-5159 | 2020-05-06 |
| 1285268391 | Artius Dermatology Associates PC | Non-Pharmacy Dispensing Site | 1337 S Lovers Ln Ste D, Visalia, CA 93292-5249 | 2020-02-27 |
| 1790327732 | Triumph Specialties LLC | Non-Pharmacy Dispensing Site | 11100 Sepulveda Blvd # 8-519, Mission Hills, CA 91345-1131 | 2019-10-10 |
| 1487210365 | Artius Dermatology Associates P.C. | Non-Pharmacy Dispensing Site | 325 Mall Dr Ste 111, Hanford, CA 93230-5950 | 2019-05-15 |
| 1376030080 | Jane F Kardashian Md Inc | Non-Pharmacy Dispensing Site | 6769 N Fresno, Fresno, CA 93710 | 2018-04-18 |
| 1023511045 | Performance Health Medical Group | Non-Pharmacy Dispensing Site | 25431 Cabot Road Suite 118, Laguna Hills, CA 92653 | 2018-03-15 |
| 1043719206 | Southern California Orthopedic Institute L.p | Non-Pharmacy Dispensing Site | 4100 Empire Dr Ste 120, Bakersfield, CA 93309-0408 | 2018-02-02 |
| 1174032353 | Golden Gate Urology, Inc. | Non-Pharmacy Dispensing Site | 139 Townsend St Ste 100, San Francisco, CA 94107-1946 | 2017-09-20 |
| 1215462080 | Mas Management Group, Inc. | Non-Pharmacy Dispensing Site | 28446 Constellation Rd, Valencia, CA 91355-5081 | 2017-04-28 |
| 1730624719 | St. John's Well Child and Family Center Inc | Non-Pharmacy Dispensing Site | 326 W 23rd St, Los Angeles, CA 90007-2612 | 2016-12-29 |
| 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 CANYON LAKE URGENT & FAMILY CARE.
| 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.