Southern California Primary Care Canyon Lake Urgent & Family Care

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

A48943 Issued in CA

Legal business name

SOUTHERN CALIFORNIA PRIMARY CARE CANYON LAKE URGENT & FAMILY CARE

Practice address

31581 Canyon Estates Dr
Lake Elsinore, CA 92532-0424

Phone

(951) 244-3500

NPI assigned

Jul 9, 2012

Organization subpart

Yes

Parent organization

MEDVANTX, INC.As reported in NPPES

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

Authorized official

Name

Kenny Heine

Title

VP Ops

Phone

(858) 964-1506

Specialties & licenses 1

Addresses

Other names 1

• DANESH MEDICAL GROUP Doing business as

Part of

Tri - State Medical Group Inc

Practitioners 2

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

• Mohammad Reza Danesh, M.D.

  • Family Medicine Physician
  • Lake Elsinore, CA
  • NPI 1811999261
  NPD
• Lisa Rogers, PHYSICIAN ASSISTANT

  • Physician Assistant
  • San Bernardino, CA
  • NPI 1619391182
  NPD

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

{
    "created_epoch": "1341792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351123200000",
    "number": "1710242474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31581 CANYON ESTATES DR",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925320424",
            "telephone_number": "951-244-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA PRIMARY CARE CANYON LAKE URGENT & FAMILY CARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2012-07-09",
        "last_updated": "2012-10-25",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "VP OPS",
        "authorized_official_telephone_number": "858-964-1506"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "CA",
            "license": "A48943",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DANESH MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Soheil Pishgar Levi DDS Inc
• Erick Solis
• Reina Soliz
• Anna Marie Soriano-Samson, NP-C
• Olga P. Soto
• Southern California Primary Care Medical Group, Inc
• Penny Lynne Speakerworth
• Andrea Spector
• Karrene Louise Stanard
• Star Speech Therapy Inc.

• Non-Pharmacy Dispensing Site in Lake Elsinore, CA
• Providers in Lake Elsinore, CA by specialty
• Non-Pharmacy Dispensing Site in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2012; 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.