MEDICARE: ADA MBAI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WM0705X	Medical-Surgical Registered Nurse	95130790	CA

General Provider Information

NPI Number	:	1053125583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADA MBAI

Provider Business Mailing Address
First Line	:	1110 N SOLANO PRIVADO APT B
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91764-6845
Country	:	US
Telephone Number	:	412-537-8982
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 N SOLANO PRIVADO APT B
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91764-6845
Country	:	US
Telephone Number	:	412-537-8982
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2025
Last Update Date	:	02/05/2025

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Directions to “ ADA MBAI ” Practice Location

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