Organization
HEACOCK HEALTH MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAFAEL PENUNURI (MEDICAL DIRECTOR)
(951) 247-8005
Entity
Organization
Contact information
Practice address
24060 FIR AVE STE A, MORENO VALLEY, CA 92553-2895
(951) 247-8005
(951) 247-8007
Mailing address
24060 FIR AVE STE A, MORENO VALLEY, CA 92553-2895
(951) 247-8005
(951) 247-8007
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760896336
—
CA
Enumeration date
02/14/2019
Last updated
04/15/2025
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