Healthcare Provider Details

I. General information

NPI: 1629729355
Provider Name (Legal Business Name): TRUCARE IPA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1749 S EUCLID AVE STE A
ONTARIO CA
91762-5832
US

IV. Provider business mailing address

1749 S EUCLID AVE STE A
ONTARIO CA
91762-5832
US

V. Phone/Fax

Practice location:
  • Phone: 909-972-0300
  • Fax: 909-984-4878
Mailing address:
  • Phone: 909-972-0300
  • Fax: 909-984-4878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: JOSE BENITO ALVAREZ DE LA LLANA
Title or Position: PRESIDENT
Credential: MD
Phone: 909-961-7881