Healthcare Provider Details

I. General information

NPI: 1073058103
Provider Name (Legal Business Name): MAY MEDICAL MANAGEMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2016
Last Update Date: 04/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 FOOTHILL BLVD
LA VERNE CA
91750-3329
US

IV. Provider business mailing address

1234 FOOTHILL BLVD
LA VERNE CA
91750-3329
US

V. Phone/Fax

Practice location:
  • Phone: 909-596-4879
  • Fax: 909-596-9199
Mailing address:
  • Phone: 909-596-4879
  • Fax: 909-596-9199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SADIQ MANDILAWI
Title or Position: CO-OWNER
Credential: MD
Phone: 909-596-4879