Provider Demographics
NPI:1407813660
Name:POMONA VALLEY HOSPITAL MEDICAL CENTER
Entity Type:Organization
Organization Name:POMONA VALLEY HOSPITAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JULI
Authorized Official - Middle Name:
Authorized Official - Last Name:HESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-865-9881
Mailing Address - Street 1:1798 N. GAREY AVE.
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767
Mailing Address - Country:US
Mailing Address - Phone:909-865-9500
Mailing Address - Fax:909-620-0479
Practice Address - Street 1:1798 N. GAREY AVE.
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767
Practice Address - Country:US
Practice Address - Phone:909-865-9500
Practice Address - Fax:909-620-0479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSC30231FMedicaid
CALTC55502FMedicaid
CAZZT30231FMedicaid
CA050231OtherBLUE CROSS
CAZZT40231FMedicaid
CAZZZA1924ZOtherBLUE SHIELD
CAZZT30231FMedicaid
CAHSC30231FMedicaid
CA050231Medicare Oscar/Certification