Healthcare Provider Details

I. General information

NPI: 1710330352
Provider Name (Legal Business Name): LITTLE STAR HEALTHCARE LITTLE STAR PEDIATRIC URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2016
Last Update Date: 07/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10590 TOWN CENTER DR
RANCHO CUCAMONGA CA
91730-0360
US

IV. Provider business mailing address

10590 TOWN CENTER DR
RANCHO CUCAMONGA CA
91730-0360
US

V. Phone/Fax

Practice location:
  • Phone: 909-328-4313
  • Fax:
Mailing address:
  • Phone: 909-328-4313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAVI GAREHGRAT
Title or Position: OWNER
Credential: MD
Phone: 443-631-2778