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General NPI Number Information
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NPI Number | 1801232459
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Entity Type | Organization
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Legal Business Name | FOOTHILL ACCOUNTABLE CARE MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 05/21/2013
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Last Update Date | 05/21/2013
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Provider Practice Location Address
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Address Line | 840 TOWNE CENTER DR
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City | POMONA
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State | CA
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Zip | 91767-5900
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Country | US
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Telephone | 909-398-1562
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Fax |
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Provider Business Mailing Address
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Address Line | 840 TOWNE CENTER DR
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City | POMONA
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State | CA
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Zip | 91767-5900
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Country | US
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Telephone | 909-398-1562
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ASHOK V. SHARMA
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Credential | M.D.
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Telephone | 909-398-1562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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