| St. John Medical Clinic | |
|
2112 S Garey Ave Suite C Pomona CA 91766-5600 | |
| (909) 464-0520 | |
| (909) 464-0523 |
| Full Name | St. John Medical Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 2112 S Garey Ave, Pomona, California |
| Authorized Official Name and Position | Mosen M Defrawy (OWNER/MEDICAL DIRECTOR) |
| Authorized Official Contact | 9094640520 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St. John Medical Clinic 2112 S Garey Ave Suite C Pomona CA 91766-5600 Ph: (909) 464-0520 | St. John Medical Clinic 2112 S Garey Ave Suite C Pomona CA 91766-5600 Ph: (909) 464-0520 |
| NPI Number | 1700055274 |
|---|---|
| Provider Enumeration Date | 02/28/2008 |
| Last Update Date | 07/12/2023 |
| Medicare PECOS PAC ID | 4082646815 |
|---|---|
| Medicare Enrollment ID | O20050901000231 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700055274 | NPI | - | NPPES |
| 1083747612 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | A30899 (California) | Secondary |
| 261QH0100X | Clinic/center - Health Service | (* (Not Available)) | Primary |
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