Healthcare Provider Details

I. General information

NPI: 1962069393
Provider Name (Legal Business Name): ST JOHN COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2019
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 S GAREY AVE STE C
POMONA CA
91766-5600
US

IV. Provider business mailing address

2112 S GAREY AVE STE C
POMONA CA
91766-5600
US

V. Phone/Fax

Practice location:
  • Phone: 909-464-0520
  • Fax: 909-464-0523
Mailing address:
  • Phone: 909-464-0520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VALERIE ANN FRANCO
Title or Position: CFO
Credential:
Phone: 909-464-0520