Organization
CANYON SPRINGS MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FAHEEM M. JUKAKU M.D. (PRESIDENT)
(951) 486-5610
Entity
Organization
Contact information
Practice address
26520 CACTUS AVE RM B2018, MORENO VALLEY, CA 92555-3927
(951) 486-5610
(951) 486-5620
Mailing address
26520 CACTUS AVE, MORENO VALLEY, CA 92555-3927
(951) 486-5610
(951) 486-5620
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0088740
—
CA
Enumeration date
01/26/2007
Last updated
04/23/2018
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