| Sotara Manalo Rico Professional Medical Corporation | |
|
5253 Riverside Dr Chino CA 91710-4151 | |
| (909) 464-2845 | |
| (909) 464-2848 |
| Full Name | Sotara Manalo Rico Professional Medical Corporation |
|---|---|
| Speciality | Family Medicine |
| Location | 5253 Riverside Dr, Chino, California |
| Authorized Official Name and Position | Sotara Manalo Rico (OWNER) |
| Authorized Official Contact | 9094642845 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sotara Manalo Rico Professional Medical Corporation 1601 Las Lunas St Pasadena CA 91106-1302 Ph: (925) 457-1235 | Sotara Manalo Rico Professional Medical Corporation 5253 Riverside Dr Chino CA 91710-4151 Ph: (909) 464-2845 |
| NPI Number | 1962932632 |
|---|---|
| Provider Enumeration Date | 06/15/2017 |
| Last Update Date | 03/03/2020 |
| Medicare PECOS PAC ID | 1658644182 |
|---|---|
| Medicare Enrollment ID | O20170906000723 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962932632 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Sotara M Rico |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962654392 PECOS PAC ID: 2466581780 Enrollment ID: I20100525000971 |
| Provider Name | Kimberly Ta |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639839418 PECOS PAC ID: 8921499856 Enrollment ID: I20220103000648 |
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