1760689715 NPI number — TOTALCARE WALK IN CLINIC INC

Table of content: (NPI 1760689715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760689715 NPI number — TOTALCARE WALK IN CLINIC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOTALCARE WALK IN CLINIC INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760689715
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13768 ROSWELL AVE
Provider Second Line Business Mailing Address:
SUITE 118
Provider Business Mailing Address City Name:
CHINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91710-1401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-591-8200
Provider Business Mailing Address Fax Number:
909-591-8229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13768 ROSWELL AVE
Provider Second Line Business Practice Location Address:
SUITE 118
Provider Business Practice Location Address City Name:
CHINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91710-1401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-591-8200
Provider Business Practice Location Address Fax Number:
866-701-9305
Provider Enumeration Date:
07/02/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ZHANG
Authorized Official First Name:
XIAO-LING
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
909-591-8200

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)