Healthcare Provider Details

I. General information

NPI: 1972955730
Provider Name (Legal Business Name): MONTCLAIR MEDICAL PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9675 MONTE VISTA AVE STE C
MONTCLAIR CA
91763-2213
US

IV. Provider business mailing address

495 E RINCON ST STE 215
CORONA CA
92879-1378
US

V. Phone/Fax

Practice location:
  • Phone: 855-505-7467
  • Fax: 888-975-8926
Mailing address:
  • Phone: 951-523-0117
  • Fax: 951-475-7013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JAVIER R RIOS
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 951-354-3221