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NPI Code Detail

MEDICARE: HUMANICARE, INC.

MEDICARE: HUMANICARE, INC.
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
1207Q00000XFamily Medicine PhysicianA97235CA

General Provider Information

NPI Number : 1639672470
Entity Type Code : Organization
Provider Name (Legal Business Name) : HUMANICARE, INC.
Provider Business Mailing Address
First Line : 15076 CANON LN
Second Line :
City : CHINO HILLS
State : CA
Zip : 91709-5211
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 13920 CITY CENTER DR STE 290
Second Line :
City : CHINO HILLS
State : CA
Zip : 91709-5444
Country : US
Telephone Number : 909-973-7772
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : PETTER MATTAR
Credential : M.D.
Telephone Number : 909-973-7772
Provider Enumeration Date : 03/16/2018
Last Update Date : 03/16/2018

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