Provider Demographics
NPI:1902903388
Name:POMONA VALLEY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:POMONA VALLEY MEDICAL GROUP, INC.
Other - Org Name:PROMED HEALTH NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CARPE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:909-932-1045
Mailing Address - Street 1:4150 E. CONCOURS STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-4989
Mailing Address - Country:US
Mailing Address - Phone:909-932-1045
Mailing Address - Fax:909-931-5077
Practice Address - Street 1:4150 E. CONCOURS STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-4989
Practice Address - Country:US
Practice Address - Phone:909-932-1045
Practice Address - Fax:909-931-5077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty