1174916092 NPI number — CARE FOR WOMENS MEDICAL GROUP INC

Table of content: (NPI 1174916092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174916092 NPI number — CARE FOR WOMENS MEDICAL GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARE FOR WOMENS MEDICAL GROUP 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:
1174916092
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1310 SAN BERNARDINO RD
Provider Second Line Business Mailing Address:
201
Provider Business Mailing Address City Name:
UPLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91786-4979
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-355-7855
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12442 LIMONITE AVE
Provider Second Line Business Practice Location Address:
207
Provider Business Practice Location Address City Name:
EASTVALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91752-2402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-356-8000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/17/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
FRANKLIN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
909-355-7855

Provider Taxonomy Codes

  • Taxonomy code: 207VX0000X , with the licence number:  20A7957 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VG0400X , with the licence number: 20A7957 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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