| David E Engelhardt Md Inc | |
|
631 N 13th Ave Ste B Upland CA 91786-4964 | |
| (909) 931-3838 | |
| (909) 931-3349 |
| Full Name | David E Engelhardt Md Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 631 N 13th Ave Ste B, Upland, California |
| Authorized Official Name and Position | David Edward Engelhardt (PRESIDENT) |
| Authorized Official Contact | 9099313838 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| David E Engelhardt Md Inc 631 N 13th Ave Ste B Upland CA 91786-4964 Ph: (909) 931-3838 | David E Engelhardt Md Inc 631 N 13th Ave Ste B Upland CA 91786-4964 Ph: (909) 931-3838 |
| NPI Number | 1295971778 |
|---|---|
| Provider Enumeration Date | 01/05/2009 |
| Last Update Date | 01/17/2019 |
| Medicare PECOS PAC ID | 2668523507 |
|---|---|
| Medicare Enrollment ID | O20090706000454 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295971778 | NPI | - | NPPES |
| 00G635290 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | G63529 (California) | Primary |
| Provider Name | David E Engelhardt |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972595122 PECOS PAC ID: 8628133469 Enrollment ID: I20090211000652 |
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