| M. Jay Porcelli Do A Medical Corporation | |
|
336 Ervilla St Pomona CA 91767-3016 | |
| (909) 620-1955 | |
| (909) 623-0720 |
| Full Name | M. Jay Porcelli Do A Medical Corporation |
|---|---|
| Speciality | Family Medicine |
| Location | 336 Ervilla St, Pomona, California |
| Authorized Official Name and Position | Martin Jay Porcelli (CEO & PRESIDENT) |
| Authorized Official Contact | 9096201955 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| M. Jay Porcelli Do A Medical Corporation 336 Ervilla St Pomona CA 91767-3016 Ph: (909) 620-1955 | M. Jay Porcelli Do A Medical Corporation 336 Ervilla St Pomona CA 91767-3016 Ph: (909) 620-1955 |
| NPI Number | 1679998694 |
|---|---|
| Provider Enumeration Date | 02/27/2014 |
| Last Update Date | 03/11/2014 |
| Medicare PECOS PAC ID | 0648400606 |
|---|---|
| Medicare Enrollment ID | O20140313001122 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679998694 | NPI | - | NPPES |
| 20A4403 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | 20A4403 (California) | Primary |
| 208VP0000X | Pain Medicine - Pain Medicine | 20A4403 (California) | Secondary |
| Provider Name | Martin J Porcelli |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124096847 PECOS PAC ID: 5799799573 Enrollment ID: I20060131000956 |
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