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General NPI Number Information
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NPI Number | 1437959095
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Entity Type | Organization
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Legal Business Name | DOCTOR'S MANAGED COMMUNITY HEALTH CENTER, INC
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Dates
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Enumeration Date | 03/13/2025
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 1520 N MOUNTAIN AVE STE 128
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City | ONTARIO
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State | CA
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Zip | 91762-1132
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Country | US
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Telephone | 909-949-9299
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Fax | 909-949-9029
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Provider Business Mailing Address
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Address Line | 851 W MOUNTAIN ST
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City | GLENDALE
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State | CA
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Zip | 91202-1047
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Country | US
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Telephone | 818-515-2309
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. NAGASAMUDRA S ASHOK
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Credential | MD
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Telephone | 818-515-8804
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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 |
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License Number State |
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