Promesa Primary Care, LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

PROMESA PRIMARY CARE, LLC

Practice address

3978 Brockton Ave
Riverside, CA 92501-3203

Phone

(951) 213-6505

Fax

(951) 213-6549

NPI assigned

Apr 8, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Omar Gomez

Title

Administrator

Phone

(951) 213-6505

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1460073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460073600000",
    "number": "1346604022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3978 BROCKTON AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925013203",
            "telephone_number": "951-213-6505",
            "fax_number": "951-213-6549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3978 BROCKTON AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925013203",
            "telephone_number": "951-213-6505",
            "fax_number": "951-213-6549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROMESA PRIMARY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-08",
        "last_updated": "2016-04-08",
        "status": "A",
        "authorized_official_last_name": "GOMEZ",
        "authorized_official_first_name": "OMAR",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "951-213-6505"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Home Health Agency in Riverside, CA
• Providers in Riverside, CA by specialty
• Home Health Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.