Healthcare Provider Details

I. General information

NPI: 1801395173
Provider Name (Legal Business Name): NEW BEGINNINGS MEDICAL GROUP, PC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 N SAN ANTONIO AVE STE 330
UPLAND CA
91786-7415
US

IV. Provider business mailing address

7535 WEAVER ST
HIGHLAND CA
92346-5922
US

V. Phone/Fax

Practice location:
  • Phone: 909-931-0446
  • Fax: 909-931-1346
Mailing address:
  • Phone: 909-862-0771
  • Fax: 909-931-1346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. LELANIE FUENTES DENILA
Title or Position: PRESIDENT
Credential: RN
Phone: 909-815-7340