Provider Demographics
NPI:1114898244
Name:BUSH MEDICAL PC
Entity type:Organization
Organization Name:BUSH MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMASAR
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:818-355-6167
Mailing Address - Street 1:3600 LIME ST BLDG 2
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-2971
Mailing Address - Country:US
Mailing Address - Phone:818-355-6167
Mailing Address - Fax:
Practice Address - Street 1:1525 E ONTARIO AVE STE 103
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-3794
Practice Address - Country:US
Practice Address - Phone:951-279-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty