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General NPI Number Information
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NPI Number | 1689884504
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Entity Type | Organization
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Legal Business Name | DONNA LEFFLER HEALTH CLINIC
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 815 S WILLOW AVE
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City | RIALTO
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State | CA
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Zip | 92376-6934
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Country | US
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Telephone | 909-820-7785
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Fax | 909-820-7770
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Provider Business Mailing Address
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Address Line | 815 S WILLOW AVE
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City | RIALTO
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State | CA
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Zip | 92376-6934
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Country | US
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Telephone | 909-820-7785
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Fax | 909-820-7770
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Authorized Official
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Title or Position | DIRECTOR OF HEALTH SERVICES
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Name | MRS. ANNETTE MCCORMICK WITKOFSKY
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Credential | RNPNP
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Telephone | 909-820-8775
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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 | CH02077
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License Number State | CA
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