Provider Demographics
NPI:1316366560
Name:AFFORDABLE CARE PROVIDERS INC.
Entity Type:Organization
Organization Name:AFFORDABLE CARE PROVIDERS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRENALYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:909-709-7941
Mailing Address - Street 1:25612 BARTON RD
Mailing Address - Street 2:335
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3110
Mailing Address - Country:US
Mailing Address - Phone:909-709-7941
Mailing Address - Fax:888-519-0834
Practice Address - Street 1:721 NEVADA ST
Practice Address - Street 2:404
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-8079
Practice Address - Country:US
Practice Address - Phone:909-709-7941
Practice Address - Fax:888-519-0834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 13242363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ06316ZMedicare UPIN