MEDICARE: DR. DAVID ALLAN CONNETT D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	20A9771	CA

General Provider Information

NPI Number	:	1396942983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID ALLAN CONNETT D.O.

Provider Business Mailing Address
First Line	:	309 E 2ND ST
Second Line	:	HPC 2ND FLOOR SUITE 2255 OR 2215
City	:	POMONA
State	:	CA
Zip	:	91766-1854
Country	:	US
Telephone Number	:	909-469-8332
Fax Number	:	909-706-3780

Provider Business Practice Location Address
First Line	:	8686 HAVEN AVE
Second Line	:	SUITE 200
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-9109
Country	:	US
Telephone Number	:	909-706-3950
Fax Number	:	909-257-2300

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2007
Last Update Date	:	05/14/2013

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