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General NPI Number Information
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NPI Number | 1396545844
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Entity Type | Organization
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Legal Business Name | LIFE POINT MEDICAL GROUP URGENT CARE
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Dates
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Enumeration Date | 03/14/2025
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Last Update Date | 03/14/2025
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Provider Practice Location Address
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Address Line | 9057 CENTRAL AVE
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City | MONTCLAIR
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State | CA
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Zip | 91763-1622
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Country | US
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Telephone | 909-398-4958
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Fax |
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Provider Business Mailing Address
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Address Line | 9057 CENTRAL AVE
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City | MONTCLAIR
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State | CA
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Zip | 91763-1622
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | DR. JOSE VELASQUEZ
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Credential | MD
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Telephone | 760-514-1430
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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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