Healthcare Provider Details

I. General information

NPI: 1972718062
Provider Name (Legal Business Name): POMONA ORTHOPEDIC & MULTISPECIALTY MEDICAL ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 ROYALTY DR
POMONA CA
91767-3020
US

IV. Provider business mailing address

1902 ROYALTY DR STE. 120
POMONA CA
91767-3030
US

V. Phone/Fax

Practice location:
  • Phone: 909-622-5600
  • Fax: 909-622-5621
Mailing address:
  • Phone: 909-622-5600
  • Fax: 909-622-5621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number14146
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC15347
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA66353
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA33890
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG39717
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberA71385
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA61974
License Number StateCA

VIII. Authorized Official

Name: DR. ROBERT E. PAZ
Title or Position: VICE PRESIDENT
Credential: D.C.
Phone: 909-622-5600