Provider Demographics
NPI:1043565096
Name:POMONA VALLEY COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:POMONA VALLEY COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:DI SARLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-868-6666
Mailing Address - Street 1:1568 N ORANGE GROVE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3812
Mailing Address - Country:US
Mailing Address - Phone:909-868-6666
Mailing Address - Fax:909-868-0206
Practice Address - Street 1:1568 N ORANGE GROVE AVE STE A
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3812
Practice Address - Country:US
Practice Address - Phone:909-868-6666
Practice Address - Fax:909-868-0206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACOMMUNITY CLINIC261QC1500X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care