Provider Demographics
NPI:1902167521
Name:CIMA
Entity Type:Organization
Organization Name:CIMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:PRYAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:951-278-3581
Mailing Address - Street 1:1191 MAGNOLIA AVE STE D-336
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3215
Mailing Address - Country:US
Mailing Address - Phone:951-278-3581
Mailing Address - Fax:951-278-3896
Practice Address - Street 1:1655 E 6TH ST STE A4C
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-1719
Practice Address - Country:US
Practice Address - Phone:951-278-3581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA648037171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty