Provider Demographics
NPI:1972120111
Name:HEALTHCONNECT PRACTITIONERS INC
Entity Type:Organization
Organization Name:HEALTHCONNECT PRACTITIONERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:YI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:909-868-8547
Mailing Address - Street 1:1361 ESTEL DR
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91768-2361
Mailing Address - Country:US
Mailing Address - Phone:909-868-8547
Mailing Address - Fax:
Practice Address - Street 1:1361 ESTEL DR
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-2361
Practice Address - Country:US
Practice Address - Phone:909-868-8547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-04
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty