La Sierra Medical Corporation

Primary specialty

SpecialistTaxonomy code 174400000X

License

A51399 Issued in CA

Legal business name

LA SIERRA MEDICAL CORPORATION

Practice address

10600 Magnolia Ave.
Suite I
Riverside, CA 92505-8889

Phone

(951) 324-8100

Fax

(951) 324-8103

NPI assigned

Feb 8, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Chidozie C Mbagwu, M.D., PH.DNPI 1285769364

Title

M.D., PH.D

Phone

(951) 324-8100

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Tax ID family

La Sierra Medical2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• La Sierra Medical Corp

  • Exclusive Provider Organization
  • Riverside, CA
  • NPI 1164527271
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Chidozie C Mbagwu, M.D., PH.D

  • Specialist
  • Riverside, CA
  • NPI 1285769364
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459382400000",
    "number": "1669513222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10600 MAGNOLIA AVE",
            "address_2": "SUITE I",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925058889",
            "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": "10600 MAGNOLIA AVE.",
            "address_2": "SUITE I",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925058889",
            "telephone_number": "951-324-8100",
            "fax_number": "951-324-8103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA SIERRA MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-08",
        "last_updated": "2016-03-31",
        "status": "A",
        "authorized_official_last_name": "MBAGWU",
        "authorized_official_first_name": "CHIDOZIE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "M.D., PH.D",
        "authorized_official_telephone_number": "951-324-8100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D., PH.D"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A51399",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A513990",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0100940",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kyceline Trading, LLC
• Joyce Virginia La Bianco, LMFT
• La Sierra Family Dentistry
• La Sierra High School
• La Sierra Medical Corp
• La Sierra Senior Home LLC
• La Sierra University Health Clinic
• La Sierra University Student Health Services
• La Vida Clinic Inc
• Shelah La Voyn-Sallis

• Specialist in Riverside, CA
• Providers in Riverside, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.