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General NPI Number Information
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NPI Number | 1902903388
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Entity Type | Organization
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Legal Business Name | POMONA VALLEY MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 12/29/2009
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Provider Practice Location Address
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Address Line | 4150 E. CONCOURS STREET SUITE 100
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City | ONTARIO
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State | CA
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Zip | 91764-4989
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Country | US
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Telephone | 909-932-1045
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Fax | 909-931-5077
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Provider Business Mailing Address
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Address Line | 4150 E. CONCOURS STREET SUITE 100
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City | ONTARIO
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State | CA
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Zip | 91764-4989
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Country | US
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Telephone | 909-932-1045
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Fax | 909-931-5077
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Authorized Official
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Title or Position | DIRECTOR OF MANAGED CARE FINANCE
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Name | MR. RICHARD CARPE
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Credential | C.P.A.
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Telephone | 909-932-1045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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