Healthcare Provider Details

I. General information

NPI: 1457105587
Provider Name (Legal Business Name): POMONA DEL SOL ADHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3240 N GAREY AVE
POMONA CA
91767-1308
US

IV. Provider business mailing address

3240 N GAREY AVE
POMONA CA
91767-1308
US

V. Phone/Fax

Practice location:
  • Phone: 877-201-7377
  • Fax:
Mailing address:
  • Phone: 877-201-7377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BOYU LIU
Title or Position: PRESIDENT
Credential:
Phone: 949-561-0999