| John A Fagan Md Family Practice Inc | |
|
10787 Laurel St Rancho Cucamonga CA 91730-3828 | |
| (909) 982-7741 | |
| (909) 931-9568 |
| Full Name | John A Fagan Md Family Practice Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 10787 Laurel St, Rancho Cucamonga, California |
| Authorized Official Name and Position | John Andrew Fagan (OWNER) |
| Authorized Official Contact | 9099827741 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| John A Fagan Md Family Practice Inc 10787 Laurel St Rancho Cucamonga CA 91730-3828 Ph: (909) 982-7741 | John A Fagan Md Family Practice Inc 10787 Laurel St Rancho Cucamonga CA 91730-3828 Ph: (909) 982-7741 |
| NPI Number | 1417130881 |
|---|---|
| Provider Enumeration Date | 12/08/2007 |
| Last Update Date | 02/04/2013 |
| Medicare PECOS PAC ID | 4880764471 |
|---|---|
| Medicare Enrollment ID | O20080609000673 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417130881 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | G060968 (California) | Primary |
| Provider Name | John A Fagan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306904628 PECOS PAC ID: 7618961970 Enrollment ID: I20040412000355 |
| Provider Name | Imdad Ahmad |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568499606 PECOS PAC ID: 8426067828 Enrollment ID: I20060412000672 |
| Provider Name | Mike Zuniga |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578791588 PECOS PAC ID: 6103061684 Enrollment ID: I20130404000362 |
| Provider Name | Darlene Espinosa |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619105541 PECOS PAC ID: 0648416933 Enrollment ID: I20130410000584 |
| Provider Name | Renier Rosquete-mendez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285110635 PECOS PAC ID: 7719374982 Enrollment ID: I20220419001097 |
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