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General NPI Number Information
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NPI Number | 1982419081
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Entity Type | Organization
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Legal Business Name | OUR FAMILY MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 02/07/2025
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 5475 WALNUT AVE 1ST FLOOR, SUITE H
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City | CHINO
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State | CA
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Zip | 91710-2609
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Country | US
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Telephone | 909-591-6446
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Fax | 909-591-1309
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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 |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | ANGELICA K ALDARACA
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Credential |
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Telephone | 909-236-7994
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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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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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