Organization
ASPEN MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MAGDALEN UKACHI EMERUWA M.SC. (ADMINISTRATOR)
(951) 735-6969
Entity
Organization
Contact information
Practice address
11441 HEACOCK ST, SUITE B-1, MORENO VALLEY, CA 92557-7907
(951) 924-1906
(951) 735-8560
Mailing address
341 MAGNOLIA AVE, SUITE 201, CORONA, CA 92879-3330
(951) 735-6969
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ28499Z
MEDICARE PTAN
CA
Enumeration date
04/01/2015
Last updated
02/07/2024
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