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General NPI Number Information
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NPI Number | 1235589086
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Entity Type | Organization
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Legal Business Name | JOSE DE LA LLANA M.D.. INC
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Dates
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Enumeration Date | 06/13/2016
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Last Update Date | 06/09/2024
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Provider Practice Location Address
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Address Line | 850 W HIGHLAND AVE SUITE A
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City | SAN BERNARDINO
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State | CA
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Zip | 92405-3855
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Country | US
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Telephone | 909-886-7576
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Fax | 909-882-4921
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Provider Business Mailing Address
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Address Line | 850 W HIGHLAND AVE SUITE A
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City | SAN BERNARDINO
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State | CA
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Zip | 92405-3855
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Country | US
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Telephone | 909-886-7576
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Fax | 909-882-4921
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Authorized Official
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Title or Position | MANAGER
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Name | GABRIEL PULGARIN
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Credential |
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Telephone | 909-886-7576
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A101657
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License Number State | CA
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