# HEACOCK HEALTH MEDICAL GROUP, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891251849
- **Authorized official:** DR. RAFAEL PENUNURI (MEDICAL DIRECTOR)
- **Authorized official phone:** (951) 247-8005

## Contact information

- **Practice address:** 24060 FIR AVE STE A, MORENO VALLEY, CA 92553-2895
- **Practice address phone:** (951) 247-8005
- **Practice address fax:** (951) 247-8007
- **Mailing address:** 24060 FIR AVE STE A, MORENO VALLEY, CA 92553-2895
- **Mailing address phone:** (951) 247-8005
- **Mailing address fax:** (951) 247-8007

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 261QU0200X | Urgent Care Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 02/14/2019
- **Last updated:** 04/15/2025