Healthcare Provider Details

I. General information

NPI: 1043787203
Provider Name (Legal Business Name): HUMMINGBIRD HEALTH ORGANIZATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2018
Last Update Date: 10/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 N RIVERSIDE AVE
RIALTO CA
92376-5926
US

IV. Provider business mailing address

326 N RIVERSIDE AVE
RIALTO CA
92376-5926
US

V. Phone/Fax

Practice location:
  • Phone: 909-875-1864
  • Fax:
Mailing address:
  • Phone: 909-875-1864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MARCELO TOLEDO
Title or Position: PRESIDENT/DENTIST PROFESSIONAL
Credential: DDS
Phone: 909-875-1865