Provider Demographics
NPI:1851647143
Name:PROFESSIONAL MEDICAL CARE
Entity Type:Organization
Organization Name:PROFESSIONAL MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YEMANE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLDEGABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-517-0033
Mailing Address - Street 1:4774 MURIETTA ST
Mailing Address - Street 2:STE. 14
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-5155
Mailing Address - Country:US
Mailing Address - Phone:909-517-0033
Mailing Address - Fax:909-517-0057
Practice Address - Street 1:4774 MURIETTA ST
Practice Address - Street 2:STE. 14
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-5155
Practice Address - Country:US
Practice Address - Phone:909-517-0033
Practice Address - Fax:909-517-0057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2019-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6710190001Medicare NSC