Healthcare Provider Details

I. General information

NPI: 1366287708
Provider Name (Legal Business Name): CENTRAL MEDICAL PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8891 N CENTRAL AVE SUITE A
MONTCLAIR CA
91763
US

IV. Provider business mailing address

8891 CENTRAL AVE STE A
MONTCLAIR CA
91763-1685
US

V. Phone/Fax

Practice location:
  • Phone: 432-294-5833
  • Fax: 909-621-1397
Mailing address:
  • Phone: 909-297-3361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JANE T HIMMELVO
Title or Position: CEO
Credential: MD
Phone: 432-294-5833