Healthcare Provider Details

I. General information

NPI: 1144517863
Provider Name (Legal Business Name): MT. VERNON COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 N MOUNT VERNON AVE SUITE C
SAN BERNARDINO CA
92411-1427
US

IV. Provider business mailing address

1655 N MOUNT VERNON AVE SUITE C
SAN BERNARDINO CA
92411-1427
US

V. Phone/Fax

Practice location:
  • Phone: 909-586-6271
  • Fax: 888-777-0807
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: RUZAN GEVORKYAN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 909-586-6271