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General NPI Number Information
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NPI Number | 1215022918
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Entity Type | Organization
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Legal Business Name | CALIFORNI MEDICAL CLINIC INC
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 09/18/2008
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Provider Practice Location Address
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Address Line | 16701 VALLEY BLVD
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City | FONTANA
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State | CA
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Zip | 92335-6696
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Country | US
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Telephone | 909-467-1605
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Fax | 909-467-1608
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Provider Business Mailing Address
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Address Line | 16701 VALLEY BLVD
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City | FONTANA
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State | CA
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Zip | 92335-6696
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Country | US
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Telephone | 909-467-1605
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Fax | 909-467-1608
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | LELAND MATHEW LUNA
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Credential | DO
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Telephone | 909-467-1605
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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 |
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License Number State |
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