MONTCLAIR COMMUNITY HEALTH CENTER (NPI# 1508373119) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508373119 |
| Entity Type | Organization |
| Organization Name | MONTCLAIR COMMUNITY HEALTH CENTER |
| Practice Address |
5050 San Bernardino St Montclair CA 91763-2326 |
| Practice Telephone | 9092815800 |
| Practice Fax Number | 9092815858 |
| Mailing Telephone | 9092815800 |
| Mailing Fax Number | 9092815858 |
| Enumeration Date | 2018-01-04 |
| Last Update Date | 2018-01-04 |
| Authorized Official Name | JAMES LALLY (PRESIDENT) |
| Authorized Official Telephone | 9092815800 |
| Authorized Official Credential | DO |
| Is Organization Subpart | Y |
| Parent Organization Name | HEALTH SERVICE ALLIANCE |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103T00000X | Psychologist | Behavioral Health & Social Service Providers | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 1407306772 | 05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MONTCLAIR COMMUNITY HEALTH CENTER | 13193 Central Ave Ste 100, Chino, CA 91710-4179 |
| Street Address |
5050 SAN BERNARDINO ST |
| City | MONTCLAIR |
| State | CA |
| Zip Code | 91763-2326 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114013026 | Mary Black-williams | Nurse Practitioner | 5050 San Bernardino St, Montclair, CA 91763-2326 | 2006-10-05 |
| 1063929420 | Ariop Psychology Group, Inc. | Psychologist | 5050 San Bernardino St, Montclair, CA 91763-2326 | 2018-01-08 |
| 1407306772 | Lally Medical Group, A Professional Corporation | Family Medicine | 5050 San Bernardino St, Montclair, CA 91763-2326 | 2016-10-10 |
| 1851847156 | Farid Didari Dpm PC | Podiatrist | 5050 San Bernardino St, Montclair, CA 91763-2326 | 2016-08-28 |
| 1376950857 | Justin Paul Delatore | Family Medicine | 5050 San Bernardino St, Montclair, CA 91763-2326 | 2014-07-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194335760 | Cho Jeon Yun Dental Partnership | Dentist | 9655 Monte Vista Ave #406, Montclair, CA 91763 | 2020-08-07 |
| 1215498811 | Above Urgent Care Center | Emergency Medicine | 8891 N. Central Ave Ste A, Montclair, CA 91763 | 2019-03-27 |
| 1467936906 | Bronislava Kroulik | Behavior Technician | 4950 San Bernardino St Ste 101, Montclair, CA 91763 | 2018-09-20 |
| 1063936110 | Monique Karina Enriquez | Licensed Vocational Nurse | 5580 Moreno St #82, Montclair, CA 91763 | 2017-07-31 |
| 1972961159 | Lacy Pinsky | Specialist/Technologist | 5035 Flora St., Montclair, CA 91763 | 2016-02-03 |
| 1912333790 | Cinta Hospice Care Inc | Hospice Care, Community Based | 5050 Palo Verde Street, Suite 101, Montclair, CA 91763 | 2013-09-24 |
| 1720334626 | Priority One Hospice, Inc. | Hospice Care, Community Based | 4959 Palo Verde St Ste 107c, Montclair, CA 91763 | 2012-07-28 |
| 1689982498 | Paulina Trujillo Perez | Counselor | 9916 Central Ave., Montclair, CA 91763 | 2010-09-15 |
| 1982846499 | Esther Phillips Agepogu | Physician Assistant | 9301 Central Ave., Montclair, CA 91763 | 2009-03-30 |
| 1568633139 | Mahin Nosrati-jahromi | Dentist | 9509 Central Ave #d, Montclair, CA 91763 | 2008-03-21 |
| Find all providers in zip 91763 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174136097 | Gb Medical Services LLC | Family Medicine | 9670 Central Ave Ste 111, Montclair, CA 91763-2425 | 2020-08-29 |
| 1558900928 | Blue Star Medical Group | Family Medicine | 110 Squire Hill Rd, Montclair, NJ 07043-2516 | 2020-01-02 |
| 1851953335 | Leyna Phuong Tran | Family Medicine | 4881 Princeton St, Montclair, CA 91763-2241 | 2019-07-03 |
| 1356812374 | Novacare Partners LLC | Family Medicine | 34 The Fairway, Montclair, NJ 07043-2534 | 2018-12-17 |
| 1215345194 | Evan Thomas Geise | Family Medicine | 4959 Palo Verde St Ste 206a-5, Montclair, CA 91763-2342 | 2014-07-23 |
| 1184037079 | Malasa Jois Kahn | Family Medicine | 100 Valley Rd Ste 102, Montclair, NJ 07042-2200 | 2014-06-09 |
| 1013274539 | Miriam Nazmy | Family Medicine | 9550 Fremont Ave Apt E4, Montclair, CA 91763-2312 | 2012-04-22 |
| 1639479009 | Patient Centered Medical Associates, Pa | Family Medicine | 54 Plymouth St, Montclair, NJ 07042-2137 | 2010-11-01 |
| 1275842452 | Marianna B. Shimelfarb | Family Medicine | 48-50 Fairfield Street, Montclair, NJ 07042 | 2010-10-05 |
| 1649443599 | Dalia A Corleone | Family Medicine | 9675 Monte Vista Ave Ste C, Montclair, CA 91763-2213 | 2008-04-10 |
| Find all providers in MONTCLAIR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.