Provider Demographics
NPI:1174803043
Name:ABC MEDICAL CORPORATION
Entity type:Organization
Organization Name:ABC MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:
Authorized Official - Last Name:RASTOGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-652-2228
Mailing Address - Street 1:1275 E LATHAM AVE STE A
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4424
Mailing Address - Country:US
Mailing Address - Phone:951-652-2228
Mailing Address - Fax:951-925-1026
Practice Address - Street 1:1701 E FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-4632
Practice Address - Country:US
Practice Address - Phone:951-652-2228
Practice Address - Fax:951-925-1026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care