Provider Demographics
NPI:1689884504
Name:DONNA LEFFLER HEALTH CLINIC
Entity Type:Organization
Organization Name:DONNA LEFFLER HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HEALTH SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:MCCORMICK
Authorized Official - Last Name:WITKOFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:RNPNP
Authorized Official - Phone:909-820-8775
Mailing Address - Street 1:815 S WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-6934
Mailing Address - Country:US
Mailing Address - Phone:909-820-7785
Mailing Address - Fax:909-820-7770
Practice Address - Street 1:815 S WILLOW AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-6934
Practice Address - Country:US
Practice Address - Phone:909-820-7785
Practice Address - Fax:909-820-7770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACH02077261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACH02077Medicaid