Healthcare Provider Details

I. General information

NPI: 1659884278
Provider Name (Legal Business Name): J & D HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 08/31/2025
Certification Date: 08/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9635 MONTE VISTA AVE STE 205
MONTCLAIR CA
91763-2235
US

IV. Provider business mailing address

9635 MONTE VISTA AVE STE 205
MONTCLAIR CA
91763-2235
US

V. Phone/Fax

Practice location:
  • Phone: 909-906-3446
  • Fax: 909-966-4450
Mailing address:
  • Phone: 909-906-3446
  • Fax: 909-966-4450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23311
License Number StateCA

VIII. Authorized Official

Name: MR. RODOLFO MANZANO PEREZ JR.
Title or Position: ADMINISTRATOR
Credential: DNP
Phone: 909-906-3446