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1292 W Mill St Suite 105 San Bernardino CA 92410-2500 | |
(909) 383-9440 | |
(909) 383-9443 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1292 W Mill St, San Bernardino, California |
Authorized Official Name and Position | Paul C Kintanar (OFFICE MANAGER) |
Authorized Official Contact | 9092530841 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1292 W Mill St Suite 105 San Bernardino CA 92410-2500 Ph: (909) 253-0841 | 1292 W Mill St Suite 105 San Bernardino CA 92410-2500 Ph: (909) 383-9440 |
NPI Number | 1710074877 |
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Provider Enumeration Date | 10/09/2006 |
Last Update Date | 08/21/2014 |
Medicare PECOS PAC ID | 9830106111 |
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Medicare Enrollment ID | O20060310000453 |
Identifier | Type | State | Issuer |
---|---|---|---|
1710074877 | NPI | - | NPPES |
00A383760 | Medicaid | CA | |
00A383761 | Medicaid | CA | |
GR0078010 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | A383760 (California) | Primary |
Provider Name | Agnes B Kintanar |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1073713962 PECOS PAC ID: 4284641572 Enrollment ID: I20060313000148 |
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