Provider Demographics
NPI:1073116166
Name:SEVEN STAR MEDICAL GROUP INC.
Entity type:Organization
Organization Name:SEVEN STAR MEDICAL GROUP INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COTA
Authorized Official - Suffix:
Authorized Official - Credentials:MSHA
Authorized Official - Phone:951-929-8149
Mailing Address - Street 1:41889 FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-5042
Mailing Address - Country:US
Mailing Address - Phone:951-414-4007
Mailing Address - Fax:951-414-4008
Practice Address - Street 1:1515 W FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-3817
Practice Address - Country:US
Practice Address - Phone:951-414-4007
Practice Address - Fax:951-414-4008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-19
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty