Healthcare Provider Details

I. General information

NPI: 1851030019
Provider Name (Legal Business Name): SMART CHOICE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 LATHAM ST STE A
RIVERSIDE CA
92501-1766
US

IV. Provider business mailing address

12926 RILEY CT
RANCHO CUCAMONGA CA
91739-8850
US

V. Phone/Fax

Practice location:
  • Phone: 909-329-8288
  • Fax: 562-309-8477
Mailing address:
  • Phone: 909-329-8288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LASHANDA JONES
Title or Position: OFFICER
Credential:
Phone: 909-329-8288