Organization
HEMET EMERGENCY MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER BOSS (PRESIDENT)
(951) 652-2811
Entity
Organization
Contact information
Practice address
1117 E DEVONSHIRE AVE, HEMET, CA 92543-3083
(909) 652-2811
Mailing address
FILE 57351, LOS ANGELES, CA 90074-0001
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C63
CALOPTIMA
—
01
—
GR0013770
MEDI-CAL
—
01
—
ZZZ92071Z
BLUE SHIELD
—
Enumeration date
06/17/2006
Last updated
08/17/2018
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