Provider Demographics
NPI:1942793658
Name:JDCM CORPORATION
Entity Type:Organization
Organization Name:JDCM CORPORATION
Other - Org Name:TRINITY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CORAZON
Authorized Official - Middle Name:C
Authorized Official - Last Name:MANAPAT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:909-972-0300
Mailing Address - Street 1:1749 S EUCLID AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-5832
Mailing Address - Country:US
Mailing Address - Phone:909-972-0300
Mailing Address - Fax:909-984-4878
Practice Address - Street 1:1749 S EUCLID AVE STE A
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-5832
Practice Address - Country:US
Practice Address - Phone:909-972-0300
Practice Address - Fax:909-984-4878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care