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Organization
PROVIDENT HOSPITALIST ASSOCIATES, A PROFESSIONAL MEDICAL CORPORATION
Active
Organization
PROVIDENT HOSPITALIST ASSOCIATES, A PROFESSIONAL MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUNIL SUJAN M.D. (CEO)
(310) 351-4566
Entity
Organization
Contact information
Practice address
800 S MAIN ST, CORONA, CA 92882-3420
(951) 737-4343
Mailing address
1191 MAGNOLIA AVE, SUITE D #248, CORONA, CA 92879-3215
(951) 736-6325
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
A63079
CA
Other
Enumeration date
10/06/2011
Last updated
10/10/2011
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