Basic Information
| Provider Information | |||||||||
| NPI: | 1760490569 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GERIATRIC PROFESSIONAL SERVICES INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6484 BRANCH CT | ||||||||
| Address2: | |||||||||
| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928800801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9514791980 | ||||||||
| FaxNumber: | 9512846281 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 S 7TH AVE | ||||||||
| Address2: | |||||||||
| City: | BARSTOW | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923113043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602561761 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FIROZ | ||||||||
| AuthorizedOfficialFirstName: | MUSTAFA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9514791980 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | C51487 | CA | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0300X | C51487 | CA | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
No ID Information.