Healthcare Provider Details

I. General information

NPI: 1407964919
Provider Name (Legal Business Name): SANTA RITA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 N EUCLID AVE SUITE A
ONTARIO CA
91762-3456
US

IV. Provider business mailing address

437 N EUCLID AVE SUITE A
ONTARIO CA
91762-3456
US

V. Phone/Fax

Practice location:
  • Phone: 909-988-2555
  • Fax: 909-988-4447
Mailing address:
  • Phone: 909-988-2555
  • Fax: 909-988-4447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 14845
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 16663
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP 13818
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA44599
License Number StateCA

VIII. Authorized Official

Name: MRS. KELLY HONG VO
Title or Position: OFFICE MANAGER
Credential:
Phone: 909-988-2555