Organization
MORENO VALLEY COMMUNITY MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOEL A PENGSON MD (OWNER)
(951) 243-6460
Entity
Organization
Contact information
Practice address
23180 HEMLOCK AVE STE 201, MORENO VALLEY, CA 92557-8001
(951) 243-6460
(951) 243-5871
Mailing address
PO BOX 220, MORENO VALLEY, CA 92556-0220
(951) 243-6460
(951) 243-5871
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
—
—
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
—
—
1835P1200X
Pharmacotherapy Pharmacist
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
05/13/2013
Last updated
04/23/2022
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