Healthcare Provider Details

I. General information

NPI: 1174916092
Provider Name (Legal Business Name): CARE FOR WOMENS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2015
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12442 LIMONITE AVE 207
EASTVALE CA
91752-2402
US

IV. Provider business mailing address

1310 SAN BERNARDINO RD 201
UPLAND CA
91786-4979
US

V. Phone/Fax

Practice location:
  • Phone: 951-356-8000
  • Fax:
Mailing address:
  • Phone: 909-355-7855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number20A7957
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number20A7957
License Number StateCA

VIII. Authorized Official

Name: DR. FRANKLIN M JOHNSON
Title or Position: CEO
Credential: DO
Phone: 909-355-7855