| Park Sierra Medical Clinic Inc | |
|
1023 S Mount Vernon Ave Ste A Colton CA 92324-4202 | |
| (909) 533-4443 | |
| (909) 533-4483 |
| Full Name | Park Sierra Medical Clinic Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1023 S Mount Vernon Ave Ste A, Colton, California |
| Authorized Official Name and Position | Anil Donald Mall (OWNER) |
| Authorized Official Contact | 9095334443 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Park Sierra Medical Clinic Inc 1023 S Mount Vernon Ave Ste A Colton CA 92324-4202 Ph: (909) 533-4443 | Park Sierra Medical Clinic Inc 1023 S Mount Vernon Ave Ste A Colton CA 92324-4202 Ph: (909) 533-4443 |
| NPI Number | 1184833428 |
|---|---|
| Provider Enumeration Date | 05/22/2007 |
| Last Update Date | 09/09/2021 |
| Medicare PECOS PAC ID | 3678658408 |
|---|---|
| Medicare Enrollment ID | O20080304000633 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184833428 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Anil D Mall |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285656900 PECOS PAC ID: 2961410998 Enrollment ID: I20060331000571 |
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