Provider Demographics
NPI:1043575459
Name:RANCHO CUCAMONGA MEDICAL CENTER
Entity Type:Organization
Organization Name:RANCHO CUCAMONGA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:VEIRS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-945-9982
Mailing Address - Street 1:7388 CARNELIAN ST
Mailing Address - Street 2:STE D
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-1160
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7388 CARNELIAN ST
Practice Address - Street 2:STE D
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-1160
Practice Address - Country:US
Practice Address - Phone:909-945-9982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111N00000X, 2081P2900X, 363A00000X
208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty