| Montana Affinity Clinic LLC | |
|
820 N Mountain Ave Ste 103 Upland CA 91786-0000 | |
| (909) 236-5575 | |
| Not Available |
| Full Name | Montana Affinity Clinic LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 820 N Mountain Ave Ste 103, Upland, California |
| Authorized Official Name and Position | Josephine Baisa Montana (OWNER) |
| Authorized Official Contact | 9092365575 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Montana Affinity Clinic LLC 820 N Mountain Ave Ste 103 Upland CA 91786-4163 Ph: (909) 236-5575 | Montana Affinity Clinic LLC 820 N Mountain Ave Ste 103 Upland CA 91786-0000 Ph: (909) 236-5575 |
| NPI Number | 1205435864 |
|---|---|
| Provider Enumeration Date | 10/23/2020 |
| Last Update Date | 06/26/2025 |
| Certification Date | 06/26/2025 |
| Medicare PECOS PAC ID | 7113330457 |
|---|---|
| Medicare Enrollment ID | O20210106001439 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205435864 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Josephine Baisa Montana |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417984782 PECOS PAC ID: 6204017767 Enrollment ID: I20110217000084 |
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