Provider Demographics
NPI:1619144227
Name:MONTCLAIR FAMILY MEDICAL CENTER INC
Entity Type:Organization
Organization Name:MONTCLAIR FAMILY MEDICAL CENTER INC
Other - Org Name:ROYAL CARE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LEGAL MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:JOSELITO
Authorized Official - Middle Name:P
Authorized Official - Last Name:BABARAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-395-9888
Mailing Address - Street 1:653 EAST E ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-4257
Mailing Address - Country:US
Mailing Address - Phone:909-395-9888
Mailing Address - Fax:
Practice Address - Street 1:653 EAST E ST
Practice Address - Street 2:SUITE 109
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-4257
Practice Address - Country:US
Practice Address - Phone:909-395-9888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51480173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A514802Medicaid
CA00A514800OtherMEDICARE