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General NPI Number Information
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NPI Number | 1538629407
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Entity Type | Organization
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Legal Business Name | JOSE R. PILPA INC
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Dates
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Enumeration Date | 03/25/2019
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Last Update Date | 03/25/2019
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Provider Practice Location Address
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Address Line | 15201 ELEVENTH ST STE 100
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City | VICTORVILLE
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State | CA
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Zip | 92395-3735
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Country | US
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Telephone | 760-381-8860
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Fax | 760-381-8864
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Provider Business Mailing Address
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Address Line | 15201 ELEVENTH ST STE 100
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City | VICTORVILLE
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State | CA
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Zip | 92395-3735
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Country | US
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Telephone | 760-381-8860
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Fax | 760-381-8864
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JOSE R. PILPA
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Credential | MD
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Telephone | 760-381-8860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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