Provider Demographics
NPI:1194742775
Name:UY - CONCEPCION, ERLINDA T (MD)
Entity type:Individual
Prefix:
First Name:ERLINDA
Middle Name:T
Last Name:UY - CONCEPCION
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ERLINDA
Other - Middle Name:UY
Other - Last Name:CONCEPCION
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:299 W FOOTHILL BLVD
Mailing Address - Street 2:STE 212
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3804
Mailing Address - Country:US
Mailing Address - Phone:909-949-8866
Mailing Address - Fax:909-385-0379
Practice Address - Street 1:536 E FOOTHILL BLVD STE B
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3988
Practice Address - Country:US
Practice Address - Phone:909-981-5882
Practice Address - Fax:909-946-0833
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29880207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A29880Medicaid
CA00A29880Medicaid
CA00A298800Medicare ID - Type Unspecified