MEDICARE: SANTA RITA MEDICAL CENTER

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	363AM0700X	Medical Physician Assistant	PA 14845	CA
2	363AM0700X	Medical Physician Assistant	PA 16663	CA
3	363L00000X	Nurse Practitioner	NP 13818	CA
4	207Q00000X	Family Medicine Physician	A44599	CA

General Provider Information

NPI Number	:	1407964919
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTA RITA MEDICAL CENTER

Provider Business Mailing Address
First Line	:	437 N EUCLID AVE
Second Line	:	SUITE A
City	:	ONTARIO
State	:	CA
Zip	:	91762-3456
Country	:	US
Telephone Number	:	909-988-2555
Fax Number	:	909-988-4447

Provider Business Practice Location Address
First Line	:	437 N EUCLID AVE
Second Line	:	SUITE A
City	:	ONTARIO
State	:	CA
Zip	:	91762-3456
Country	:	US
Telephone Number	:	909-988-2555
Fax Number	:	909-988-4447

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. KELLY HONG VO
Credential	:
Telephone Number	:	909-988-2555

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	09/11/2025

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