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General NPI Number Information
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NPI Number | 1205187366
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Entity Type | Organization
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Legal Business Name | HEART CARE AND REHABILITATION CENTER
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Dates
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Enumeration Date | 09/28/2012
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Last Update Date | 09/28/2012
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Provider Practice Location Address
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Address Line | 319 S PARK AVE STE D
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City | POMONA
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State | CA
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Zip | 91766-1503
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Country | US
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Telephone | 909-644-6444
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Fax |
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Provider Business Mailing Address
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Address Line | 319 S PARK AVE STE D
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City | POMONA
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State | CA
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Zip | 91766-1503
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Country | US
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Telephone | 909-644-6444
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. BARBARA CHINEDU AMAJOYI
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Credential | FNP
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Telephone | 909-644-6444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | 18731
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License Number State | CA
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