Basic Information
| Provider Information | |||||||||
| NPI: | 1407964919 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SANTA RITA MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 437 N EUCLID AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917623456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099882555 | ||||||||
| FaxNumber: | 9099884447 | ||||||||
| Practice Location | |||||||||
| Address1: | 437 N EUCLID AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917623456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099882555 | ||||||||
| FaxNumber: | 9099884447 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | VO | ||||||||
| AuthorizedOfficialFirstName: | KELLY | ||||||||
| AuthorizedOfficialMiddleName: | HONG | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9099882555 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A44599 | CA | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 363AM0700X | PA 14845 | CA | X | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AM0700X | PA 16663 | CA | X | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363L00000X | NP 13818 | CA | X | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.