1164558714 NPI number — MONTE VISTA CHILD CARE CENTER

Table of content: (NPI 1164558714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164558714 NPI number — MONTE VISTA CHILD CARE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTE VISTA CHILD CARE CENTER
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:
6
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:
1164558714
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13342 VICTORIA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANCHO CUCAMONGA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91739-2020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-899-5046
Provider Business Mailing Address Fax Number:
909-463-2005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7976 BEECHWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RANCHO CUCAMONGA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91701-1830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-899-5046
Provider Business Practice Location Address Fax Number:
909-463-2005
Provider Enumeration Date:
02/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MENDOZA
Authorized Official First Name:
DEISY
Authorized Official Middle Name:
ODETT
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
909-912-9314

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X , with the licence number:  240000757 , 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)

  • Identifier: LTC60980F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: LTC60588F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: LTC60458F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: LTC60943F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: LTC60961F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: LTC60973F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: LTC60734F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: LTC60599F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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