Tri-Industrial Medical Center

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

A037286 Issued in CA

Legal business name

TRI-INDUSTRIAL MEDICAL CENTER

Practice address

10427 San Sevaine Way Ste J
Mira Loma, CA 91752-1151

Phone

(951) 360-8333

Fax

(951) 360-1401

NPI assigned

Feb 12, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Alexander Carli, M.D

Title

Owner Medical Director

Phone

(951) 360-8333

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1851433502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10427 SAN SEVAINE WAY STE J",
            "city": "MIRA LOMA",
            "state": "CA",
            "postal_code": "917521151",
            "telephone_number": "951-360-8333",
            "fax_number": "951-360-1401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10427 SAN SEVAINE WAY STE J",
            "city": "MIRA LOMA",
            "state": "CA",
            "postal_code": "917521151",
            "telephone_number": "951-360-8333",
            "fax_number": "951-360-1401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-INDUSTRIAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CARLI",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_title_or_position": "OWNER  MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "951-360-8333",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "A037286",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1205943354",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Mira Loma, CA
• Providers in Mira Loma, CA by specialty
• Clinic/Center in California

• 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.

Verify at the official NPI Registry.