| Prowellness Healthcare Inc. | |
|
8439 White Oak Ave Ste 1038439 Rancho Cucamonga CA 91730-0621 | |
| (818) 532-2222 | |
| (818) 591-7322 |
| Full Name | Prowellness Healthcare Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 8439 White Oak Ave Ste 1038439, Rancho Cucamonga, California |
| Authorized Official Name and Position | Nena Tong Arciaga (PRESIDENT) |
| Authorized Official Contact | 8185322222 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prowellness Healthcare Inc. 8439 White Oak Ave Ste 1038439 Rancho Cucamonga CA 91730-0621 Ph: (818) 532-2222 | Prowellness Healthcare Inc. 8439 White Oak Ave Ste 1038439 Rancho Cucamonga CA 91730-0621 Ph: (818) 532-2222 |
| NPI Number | 1053150698 |
|---|---|
| Provider Enumeration Date | 05/22/2024 |
| Last Update Date | 05/22/2024 |
| Medicare PECOS PAC ID | 3870027220 |
|---|---|
| Medicare Enrollment ID | O20241107004143 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053150698 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Richard Gordon |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1144242645 PECOS PAC ID: 9830096536 Enrollment ID: I20110314000460 |
| Provider Name | Mark V Recio |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215474390 PECOS PAC ID: 3577804640 Enrollment ID: I20190418001201 |
| Provider Name | Conrado A Guadiz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942937768 PECOS PAC ID: 2769846948 Enrollment ID: I20230907001538 |
| Provider Name | Hovhannes Ghazaryan |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1851910665 PECOS PAC ID: 1951765965 Enrollment ID: I20230908003550 |
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