Provider Demographics
NPI:1750787842
Name:JDCM CORPORATION
Entity type:Organization
Organization Name:JDCM CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ALVAREZ
Authorized Official - Last Name:DE LA LLANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-927-5240
Mailing Address - Street 1:1749 S EUCLID AVE
Mailing Address - Street 2:SUITE A
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
Practice Address - Street 2:SUITE A
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:2014-11-17
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101657261QU0200X, 261QF0050X, 261QH0100X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service