| Holt Medical Corporation | |
|
5153 Holt Blvd Ste B1 Montclair CA 91763-4820 | |
| (909) 603-9000 | |
| (909) 603-9008 |
| Full Name | Holt Medical Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 5153 Holt Blvd Ste B1, Montclair, California |
| Authorized Official Name and Position | Sohrab Salamatipour (OWNER) |
| Authorized Official Contact | 9096039000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Holt Medical Corporation 5153 Holt Blvd Ste B1 Montclair CA 91763-4837 Ph: (909) 603-9000 | Holt Medical Corporation 5153 Holt Blvd Ste B1 Montclair CA 91763-4820 Ph: (909) 603-9000 |
| NPI Number | 1285721571 |
|---|---|
| Provider Enumeration Date | 10/06/2006 |
| Last Update Date | 02/22/2016 |
| Medicare PECOS PAC ID | 7517025174 |
|---|---|
| Medicare Enrollment ID | O20081027000077 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285721571 | NPI | - | NPPES |
| GR0101080 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | A63781 (California) | Primary |
| Provider Name | Sohrab Salamati Pour |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1003957077 PECOS PAC ID: 9739132325 Enrollment ID: I20050223000503 |
| Provider Name | Melody L Angeles-riparip |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093752248 PECOS PAC ID: 0042278699 Enrollment ID: I20111123000532 |
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