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General NPI Number Information
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NPI Number | 1073789871
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Entity Type | Organization
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Legal Business Name | PHYSICIANS AALLIANCE NETWORK
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Dates
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Enumeration Date | 05/01/2008
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Last Update Date | 09/26/2011
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Provider Practice Location Address
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Address Line | 4150 E. CONCOURS ST. SUITE #100
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City | ONTARIO
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State | CA
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Zip | 91764-4989
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Country | US
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Telephone | 909-932-1045
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Fax | 909-932-1065
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Provider Business Mailing Address
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Address Line | P.O. BOX 2429
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91729
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Country | US
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Telephone | 909-932-1045
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Fax | 909-932-1065
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. CADRIN E. GILL
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Credential | M.D.
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Telephone | 909-932-1045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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