Provider Demographics
NPI:1215909130
Name:RANCHO CUCAMONGA PERPETUAL HELP MEDICAL CORPORATION
Entity type:Organization
Organization Name:RANCHO CUCAMONGA PERPETUAL HELP MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FLORENCIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:TAMPOYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-466-6410
Mailing Address - Street 1:8112 MILLIKEN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-7472
Mailing Address - Country:US
Mailing Address - Phone:909-466-6410
Mailing Address - Fax:909-466-5667
Practice Address - Street 1:8112 MILLIKEN AVE STE 100
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-7472
Practice Address - Country:US
Practice Address - Phone:909-466-6410
Practice Address - Fax:909-466-5667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA47994207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0101410Medicaid
CAZZZ07974ZOtherBLUE SHIELD #
CAGR0101410Medicaid
CAGR0101410Medicaid