Healthcare Provider Details

I. General information

NPI: 1033297189
Provider Name (Legal Business Name): VATSAL HAREN MODY M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10832 LAUREL ST STE 101
RANCHO CUCAMONGA CA
91730
US

IV. Provider business mailing address

10832 LAUREL ST STE 101
RANCHO CUCAMONGA CA
91730
US

V. Phone/Fax

Practice location:
  • Phone: 909-477-3015
  • Fax: 909-477-3016
Mailing address:
  • Phone: 909-477-3015
  • Fax: 909-477-3016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VATSAL H MODY
Title or Position: OWNER
Credential: M.D.
Phone: 909-477-3015