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General NPI Number Information
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NPI Number | 1831700970
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Entity Type | Organization
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Legal Business Name | DOCTORS MEDICAL PLAZA INC
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Dates
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Enumeration Date | 08/12/2020
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Last Update Date | 08/12/2020
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Provider Practice Location Address
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Address Line | 5343 RIVERSIDE DR
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City | CHINO
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State | CA
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Zip | 91710-4252
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Country | US
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Telephone | 909-465-9337
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Fax | 909-627-8106
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Provider Business Mailing Address
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Address Line | 5343 RIVERSIDE DR
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City | CHINO
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State | CA
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Zip | 91710-4252
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Country | US
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Telephone | 909-465-9337
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Fax | 909-627-8106
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | NIDIA COLOMER DE SACA
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Credential | MD
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Telephone | 909-465-9337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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