Healthcare Provider Details

I. General information

NPI: 1003235235
Provider Name (Legal Business Name): ECLER ERCOLE JAQUA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11000 EUCALYPTUS ST STE 125
RANCHO CUCAMONGA CA
91730-7724
US

IV. Provider business mailing address

11000 EUCALYPTUS ST
RANCHO CUCAMONGA CA
91730-7707
US

V. Phone/Fax

Practice location:
  • Phone: 909-694-1086
  • Fax: 909-964-1059
Mailing address:
  • Phone: 909-694-1086
  • Fax: 909-964-1059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberA143997
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA143997
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: