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MAGNOLIA ACUTE TRAUMA A MEDICAL CORPORATION NPI 1578947404


NPI Information

NPI: 1578947404
Provider Name: MAGNOLIA ACUTE TRAUMA, A MEDICAL CORPORATION
Classification: Surgery - 2086S0127X
Entity Type: Organization

Specialization: Trauma Surgery

CLIA Number: 05D2121503

Address:
4445 MAGNOLIA AVE
RIVERSIDE, CA
ZIP 92501
Phone: (469) 401-2386
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MAGNOLIA ACUTE TRAUMA, A MEDICAL CORPORATION is a trauma surgery surgery in Riverside, CA. The provider is trauma surgery is a recognized subspecialty of general surgery. Trauma surgeons are physicians who have completed a five-year general surgery residency and usually continue with a one to two year fellowship in trauma and/or surgical critical care, typically leading to additional board certification in surgical critical care. There is no trauma surgery board certification at this point. To obtain board certification in surgical critical care, a fellowship in surgical critical care or anesthesiology critical care must be completed during or after general surgery residency. MAGNOLIA ACUTE TRAUMA, A MEDICAL CORPORATION NPI is 1578947404. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

4445 MAGNOLIA AVE
RIVERSIDE, CA
ZIP 92501-135
Phone: (469) 401-2386

The provider's authorized official is Kathleen Kondas .
The authorized official title is Officer and has the following contact phone number (317) 614-9871.

The CLIA number assigned to this NPI record is 05D2121503 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/9/2015 and was last updated on 4/20/2021.


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
12086S0127XSurgeryTrauma SurgeryYes

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: 11/14/2023

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