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General NPI Number Information
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NPI Number | 1740583608
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Entity Type | Organization
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Legal Business Name | CAL-CARE INDUSTRIAL MEDICAL
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Dates
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Enumeration Date | 12/15/2010
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Last Update Date | 12/15/2010
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Provider Practice Location Address
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Address Line | 502 S GAREY AVE
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City | POMONA
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State | CA
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Zip | 91766-3319
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Country | US
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Telephone | 909-620-8887
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Fax | 909-620-8817
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Provider Business Mailing Address
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Address Line | 502 S GAREY AVE
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City | POMONA
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State | CA
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Zip | 91766-3319
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Country | US
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Telephone | 909-620-8887
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Fax | 909-620-8817
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MR. ROBERT E LADINES
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Credential | M D
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Telephone | 909-620-8887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number | A51126
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License Number State | CA
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