| Montclair Community Clinic | |
|
9655 Monte Vista Ave Ste 402a Montclair CA 91763-2238 | |
| (909) 972-0924 | |
| (909) 966-4987 |
| Full Name | Montclair Community Clinic |
|---|---|
| Speciality | Internal Medicine |
| Location | 9655 Monte Vista Ave Ste 402a, Montclair, California |
| Authorized Official Name and Position | Kenoye R Uku (OWNER) |
| Authorized Official Contact | 2064566933 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Montclair Community Clinic 9655 Monte Vista Ave Ste 402a Montclair CA 91763-2238 Ph: (909) 972-0924 | Montclair Community Clinic 9655 Monte Vista Ave Ste 402a Montclair CA 91763-2238 Ph: (909) 972-0924 |
| NPI Number | 1538908074 |
|---|---|
| Provider Enumeration Date | 05/23/2024 |
| Last Update Date | 03/11/2026 |
| Certification Date | 03/11/2026 |
| Medicare PECOS PAC ID | 1052851011 |
|---|---|
| Medicare Enrollment ID | O20240905002751 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538908074 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| 363LF0000X | Nurse Practitioner - Family | () | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | () | Secondary |
| Provider Name | Kenoye R Uku |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1013084920 PECOS PAC ID: 1254462690 Enrollment ID: I20100628000973 |
| Provider Name | Ese Ogbetuo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417423138 PECOS PAC ID: 4385073337 Enrollment ID: I20200326002912 |
| Provider Name | Peter Oziegbe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770753618 PECOS PAC ID: 0648647214 Enrollment ID: I20221110002623 |
| Provider Name | Rerhime Reri Uku |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659906147 PECOS PAC ID: 8022485754 Enrollment ID: I20221206002274 |
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