Healthcare Provider Details
I. General information
NPI: 1871747428
Provider Name (Legal Business Name): CARE FOR WOMENS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 11/10/2008
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1310 SAN BERNARDINO RD SUITE 201
UPLAND CA
91786-4979
US
IV. Provider business mailing address
1310 SAN BERNARDINO RD SUITE 201
UPLAND CA
91786-4979
US
V. Phone/Fax
- Phone: 909-355-7855
- Fax: 909-755-7856
- Phone: 909-355-7855
- Fax: 909-755-7856
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207VX0000X |
| Taxonomy | Obstetrics Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207VG0400X |
| Taxonomy | Gynecology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
FRANKLIN
M
JOHNSON
JR.
Title or Position: PRESIDENT
Credential: D.O.
Phone: 909-355-7855