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Organization
INNOVATIVE EXTENSIVIST GROUP PC
Active
Organization
INNOVATIVE EXTENSIVIST GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALMA TORRES (CREDENTIALING MANAGER)
(951) 800-8330
Entity
Organization
Contact information
Practice address
44045 MARGARITA RD STE 101, TEMECULA, CA 92592-2729
(951) 880-0701
(951) 904-3647
Mailing address
44045 MARGARITA RD STE 101, TEMECULA, CA 92592-2729
(951) 880-0701
(951) 904-3647
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
08/01/2025
Last updated
08/12/2025
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