Basic Information
| Provider Information | |||||||||
| NPI: | 1457472664 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | APEX HEALTHCARE MEDICAL CENTER INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | APEX FAMILY CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41889 E FLORIDA AVE | ||||||||
| Address2: | |||||||||
| City: | HEMET | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516528700 | ||||||||
| FaxNumber: | 9514924159 | ||||||||
| Practice Location | |||||||||
| Address1: | 28400 MCCALL BLVD STE B10 | ||||||||
| Address2: | |||||||||
| City: | MENIFEE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925859658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9514142020 | ||||||||
| FaxNumber: | 9514142021 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 06/15/2020 | ||||||||
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| AuthorizedOfficialLastName: | CHAUDHURI | ||||||||
| AuthorizedOfficialFirstName: | KALI | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9516723379 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | APEX HEALTHCARE MEDICAL CENTER INC | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 06/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | A38313 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.