Organization
LA SIERRA MEDICAL CORP
Active
Organization
LA SIERRA MEDICAL CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHIDOZIE CONSTANCE MBAGWU M.D. (MEDICAL DIRECTOR)
(951) 324-8100
Entity
Organization
Contact information
Practice address
4712B LA SIERRA AVE, RIVERSIDE, CA 92505-2726
(951) 324-8100
(951) 324-8103
Mailing address
4712B LA SIERRA AVE, RIVERSIDE, CA 92505-2726
(951) 324-8100
(951) 324-8103
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
A513990
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0100940
—
CA
Enumeration date
09/13/2006
Last updated
08/22/2020
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