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General NPI Number Information
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NPI Number | 1770285751
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Entity Type | Organization
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Legal Business Name | UNITED MEDICAL CLINIC INC OF CALIFORNIA
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Dates
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Enumeration Date | 03/21/2023
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Last Update Date | 03/21/2023
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Provider Practice Location Address
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Address Line | 692 E PHILLIPS BLVD
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City | POMONA
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State | CA
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Zip | 91766-4549
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Country | US
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Telephone | 702-969-8785
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Fax |
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Provider Business Mailing Address
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Address Line | 692 E PHILLIPS BLVD
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City | POMONA
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State | CA
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Zip | 91766-4549
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Country | US
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Telephone | 702-969-8785
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ARIAGNE ARIELLE DUAVE
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Credential |
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Telephone | 702-969-8785
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 2084B0040X
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Taxonomy Name | Behavioral Neurology & Neuropsychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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