1689661522 NPI number — MEDICAL NETWORK RESOURCE CENTER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689661522 NPI number — MEDICAL NETWORK RESOURCE CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL NETWORK RESOURCE CENTER, 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:
1689661522
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13841 ROSWELL AVE
Provider Second Line Business Mailing Address:
BLDG 12, UNIT I
Provider Business Mailing Address City Name:
CHINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91710-5467
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-590-0797
Provider Business Mailing Address Fax Number:
909-590-5297

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13841 ROSWELL AVE
Provider Second Line Business Practice Location Address:
BLDG 12, UNIT I
Provider Business Practice Location Address City Name:
CHINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91710-5467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-590-0797
Provider Business Practice Location Address Fax Number:
909-590-5297
Provider Enumeration Date:
10/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CARTER
Authorized Official First Name:
GARY
Authorized Official Middle Name:
WAYNE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
909-590-0797

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  25737 , 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)





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