| Well Of Healing Mobile Medical Clinic | |
|
7623 East Ave Fontana CA 92336-2901 | |
| (909) 463-0103 | |
| (909) 463-4840 |
| Full Name | Well Of Healing Mobile Medical Clinic |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 7623 East Ave, Fontana, California |
| Authorized Official Name and Position | Angela Coaston (ADMINISTRATOR) |
| Authorized Official Contact | 9094630103 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Well Of Healing Mobile Medical Clinic 7623 East Ave Fontana CA 92336-2901 Ph: (909) 463-0103 | Well Of Healing Mobile Medical Clinic 7623 East Ave Fontana CA 92336-2901 Ph: (909) 463-0103 |
| NPI Number | 1619195740 |
|---|---|
| Provider Enumeration Date | 04/23/2007 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619195740 | NPI | - | NPPES |
| CMM71071F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (California) | Primary |
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