MEDICARE: MONTCLAIR MEDICAL PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	208000000X	Pediatrics Physician
3	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1972955730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTCLAIR MEDICAL PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	495 E RINCON ST STE 215
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92879-1378
Country	:	US
Telephone Number	:	951-523-0117
Fax Number	:	951-475-7013

Provider Business Practice Location Address
First Line	:	9675 MONTE VISTA AVE STE C
Second Line	:
City	:	MONTCLAIR
State	:	CA
Zip	:	91763-2213
Country	:	US
Telephone Number	:	855-505-7467
Fax Number	:	888-975-8926

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	JAVIER R RIOS
Credential	:	MD
Telephone Number	:	951-354-3221

Provider Enumeration Date	:	07/05/2016
Last Update Date	:	06/06/2022

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