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General NPI Number Information
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NPI Number | 1104043835
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Entity Type | Organization
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Legal Business Name | FOOTHILL COMMUNITY MEDICAL CORPORATION
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1126 W MISSION BLVD
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City | POMONA
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State | CA
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Zip | 91766-1342
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Country | US
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Telephone | 909-865-2538
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Fax | 909-865-2508
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Provider Business Mailing Address
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Address Line | 1126 W MISSION BLVD
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City | POMONA
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State | CA
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Zip | 91766-1342
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Country | US
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Telephone | 909-865-2538
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Fax | 909-865-2508
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAFAEL CARCAMO
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Credential | M.D.
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Telephone | 909-865-2538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 00A666750
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License Number State | CA
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