Basic Information
| Provider Information | |||||||||
| NPI: | 1750802914 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEDROUS | ||||||||
| FirstName: | DAVID | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16760 BURRO RD | ||||||||
| Address2: | |||||||||
| City: | PERRIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925707122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512582014 | ||||||||
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| Practice Location | |||||||||
| Address1: | 27300 IRIS AVE | ||||||||
| Address2: | |||||||||
| City: | MORENO VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925554802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512430811 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2017 | ||||||||
| LastUpdateDate: | 06/28/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | PA54380 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.