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General NPI Number Information
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NPI Number | 1922776996
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Entity Type | Organization
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Legal Business Name | DOC1 MEDICAL GROUP PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 09/02/2021
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Last Update Date | 01/26/2022
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Provider Practice Location Address
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Address Line | 14532 CENTRAL AVE
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City | CHINO
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State | CA
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Zip | 91710-9503
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Country | US
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Telephone | 949-868-3377
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Fax | 800-881-7739
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Provider Business Mailing Address
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Address Line | 14532 CENTRAL AVE
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City | CHINO
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State | CA
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Zip | 91710-9503
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Country | US
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Telephone | 949-868-3377
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Fax | 800-881-7739
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL OPERATIONS
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Name | BENJAMIN HARMON
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Credential |
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Telephone | 714-707-0855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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