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General NPI Number Information
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NPI Number | 1235797044
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Entity Type | Organization
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Legal Business Name | MARLBORO CANCER SCREENING CENTER INC
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Dates
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Enumeration Date | 06/05/2019
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Last Update Date | 09/17/2019
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Provider Practice Location Address
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Address Line | 11340 MOUNTAIN VIEW AVE STE B
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City | LOMA LINDA
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State | CA
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Zip | 92354-3858
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Country | US
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Telephone | 888-267-9605
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Fax | 909-334-1314
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Provider Business Mailing Address
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Address Line | 14164 MOUNTAIN AVE
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City | CHINO
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State | CA
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Zip | 91710-1128
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Country | US
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Telephone | 909-927-8296
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Fax | 909-334-1314
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DHARMAKUMAR WILSON GOMER
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Credential | MD
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Telephone | 909-799-5445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QG0250X
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Taxonomy Name | Genetics Clinic/Center
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License Number |
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License Number State |
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