Healthcare Provider Details

I. General information

NPI: 1093520066
Provider Name (Legal Business Name): MEDINOVA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 02/09/2025
Certification Date: 02/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 N MOUNTAIN AVE STE 105
UPLAND CA
91786-4164
US

IV. Provider business mailing address

818 N MOUNTAIN AVE STE 105
UPLAND CA
91786-4164
US

V. Phone/Fax

Practice location:
  • Phone: 909-900-7340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMAD ALAKKAD
Title or Position: PRESIDENT
Credential:
Phone: 909-900-7340