Provider Demographics
NPI:1861178758
Name:EL MIRADOR MEDICAL PLAZA PHARMACY INC
Entity type:Organization
Organization Name:EL MIRADOR MEDICAL PLAZA PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:UPADHYAYULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-323-1001
Mailing Address - Street 1:21634 RETREAT PKWY SUITE 100
Mailing Address - Street 2:
Mailing Address - City:TEMESCAL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92883
Mailing Address - Country:US
Mailing Address - Phone:951-963-3330
Mailing Address - Fax:951-963-3331
Practice Address - Street 1:21634 RETREAT PKWY SUITE 100
Practice Address - Street 2:
Practice Address - City:TEMESCAL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92883
Practice Address - Country:US
Practice Address - Phone:951-637-0180
Practice Address - Fax:951-637-0183
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EL MIRADOR MEDICAL PLAZA PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-26
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy