National Provider Identifier Database

PRIMARY PEDIATRIC AND ADOLESCENT CLINIC INCORPORATED
Preferred Provider Organization

A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level.


Contact Information

PRIMARY PEDIATRIC AND ADOLESCENT CLINIC, INCORPORATED
8599 HAVEN AVE
STE. 101
RANCHO CUCAMONGA, CA91730-4849
Phone: 909-466-8888
Fax: 909-483-0164
Website:
Specialty Taxonomy Code
* Preferred Provider Organization 305R00000X

* Indicates primary specialty

NPI Profile & details for PRIMARY PEDIATRIC AND ADOLESCENT CLINIC, INCORPORATED

NPI Number 1326117516
Legal business name
LBN
PRIMARY PEDIATRIC AND ADOLESCENT CLINIC, INCORPORATED
Authorized official FALAHYAH MOKHTAR - (OFFICE MANAGER)
Entity Organization
Organization subpart No
Enumeration date 11/06/2006
Last updated 08/22/2020 - About 6 years ago
Sole proprietor1 Not specified
Identifiers
  • CA License #: A33327

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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