| |
18651 Valley Blvd Unit A Bloomington CA 92316-1831 | |
(951) 571-2300 | |
Not Available |
Full Name | |
---|---|
Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 18651 Valley Blvd Unit A, Bloomington, California |
Authorized Official Name and Position | Vanessa Ivonne Ortiz (EXECUTIVE ASSISTANT) |
Authorized Official Contact | 9515712379 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
22675 Alessandro Blvd Moreno Valley CA 92553-8551 Ph: (951) 571-2300 | 18651 Valley Blvd Unit A Bloomington CA 92316-1831 Ph: (951) 571-2300 |
NPI Number | 1093226243 |
---|---|
Provider Enumeration Date | 10/16/2017 |
Last Update Date | 10/16/2017 |
Identifier | Type | State | Issuer |
---|---|---|---|
1093226243 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |