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Organization
FIRST IMPACT MEDICAL GROUP, INC
Active
Organization
FIRST IMPACT MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICK MASHOUR (MEDICAL DIRECTOR)
(888) 951-9511
Entity
Organization
Contact information
Practice address
6700 INDIANA AVE, SUITE 145, RIVERSIDE, CA 92506-4290
(888) 951-9511
Mailing address
PO BOX 28807, SANTA ANA, CA 92799-8807
(888) 951-9511
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
PSY9462
CA
111N00000X
Chiropractor
21702
CA
171100000X
Acupuncturist
13813
CA
207R00000X
Internal Medicine Physician
Primary
A72007
CA
208100000X
Physical Medicine & Rehabilitation Physician
A79570
CA
213E00000X
Podiatrist
4540
CA
Other
Enumeration date
04/12/2012
Last updated
04/12/2012
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