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PITUCK MEDICAL GROUP INC. NPI 1255544557


NPI Information

NPI: 1255544557
Provider Name: PITUCK MEDICAL GROUP, INC.
Classification: Psychologist - 103TP0016X
Entity Type: Organization

Specialization: Prescribing (Medical)

Address:
5858 MAGNOLIA AVE STE C
RIVERSIDE, CA
ZIP 92506
Phone: (714) 223-0396
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PITUCK MEDICAL GROUP, INC. is a prescribing (medical) psychologist in Riverside, CA. The provider is a licensed, doctoral-level psychologist authorized to prescribe and has undergone specialized education and training in preparation for prescriptive practice and has passed an examination accepted by the state board of psychology relevant to establishing competence for prescribing, and has received from the state board of psychology a current certificate granting prescriptive authority, which has not been revoked or suspended. PITUCK MEDICAL GROUP, INC. NPI is 1255544557. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

5858 MAGNOLIA AVE STE C
RIVERSIDE, CA
ZIP 92506-886
Phone: (714) 223-0396
Fax: (714) 223-0397

The provider's authorized official is Michele Severson .
The authorized official title is Administrator and has the following contact phone number (714) 223-0396.

The enumeration date for this NPI number is 5/7/2007 and was last updated on 12/4/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1103TP0016XPsychologistPrescribing (Medical)Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1ZZZ13983ZMEDICARE ID-TYPE UNSPECIFIEDCALIFORNIAMEDICARE PROVIDER NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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