Active NPI
La Sierra Medical Corp
- Exclusive Provider Organization
- Riverside, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Exclusive Provider Organization
- License
- A513990
- Legal business name
- LA SIERRA MEDICAL CORP
- Practice address
- 4712B la Sierra Ave
Riverside, CA 92505-2726 - Phone
- (951) 324-8100
- Fax
- (951) 324-8103
- NPI assigned
- Sep 13, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Chidozie Constance Mbagwu, M.D.
- Title
- Medical Director
- Phone
- (951) 324-8100
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Exclusive Provider Organization | 302F00000X | A513990 | CA | Primary |
Addresses
Primary practice location
4712B la Sierra Ave
Riverside, CA 92505-2726
Mailing address
4712B la Sierra Ave
Riverside, CA 92505-2726
Phone (951) 324-8100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GR0100940 | Medicaid | CA |
National Provider Directory
National Provider Directory- Tax ID family
- La Sierra Medical
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Specialist
- Riverside, CA
- NPI 1669513222
Locations
4712 La Sierra Ave
Ste B
Riverside, CA 92505
Phone (951) 324-8100
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Specialist
- Riverside, CA
- NPI 1285769364
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158105600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1164527271",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4712B LA SIERRA AVE",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925052726",
"telephone_number": "951-324-8100",
"fax_number": "951-324-8103"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4712B LA SIERRA AVE",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925052726",
"telephone_number": "951-324-8100",
"fax_number": "951-324-8103"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LA SIERRA MEDICAL CORP",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-13",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "MBAGWU",
"authorized_official_first_name": "CHIDOZIE",
"authorized_official_middle_name": "CONSTANCE",
"authorized_official_title_or_position": "MEDICAL DIRECTOR",
"authorized_official_telephone_number": "951-324-8100",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "302F00000X",
"taxonomy_group": "",
"desc": "Exclusive Provider Organization",
"state": "CA",
"license": "A513990",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GR0100940",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.