Provider Demographics
NPI:1144195884
Name:MODERM MEDICAL SOLUTIONS CA INC.
Entity type:Organization
Organization Name:MODERM MEDICAL SOLUTIONS CA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:PIPPIN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-FNP
Authorized Official - Phone:760-525-5894
Mailing Address - Street 1:3350 SHELBY ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-5556
Mailing Address - Country:US
Mailing Address - Phone:888-211-1498
Mailing Address - Fax:888-211-4677
Practice Address - Street 1:2263 FINCH CIRCLE
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92582
Practice Address - Country:US
Practice Address - Phone:888-211-1498
Practice Address - Fax:888-211-4677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-10
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty