# JOSE DE LA LLANA M.D.. INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Su Clinica Medica Medical Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235589086
- **Authorized official:** GABRIEL PULGARIN (MANAGER)
- **Authorized official phone:** (909) 886-7576

## Contact information

- **Practice address:** 850 W HIGHLAND AVE, SUITE A, SAN BERNARDINO, CA 92405-3855
- **Practice address phone:** (909) 886-7576
- **Practice address fax:** (909) 882-4921
- **Mailing address:** 850 W HIGHLAND AVE, SUITE A, SAN BERNARDINO, CA 92405-3855
- **Mailing address phone:** (909) 886-7576
- **Mailing address fax:** (909) 882-4921

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | A101657 | CA | Yes |

## Other

- **Enumeration date:** 06/13/2016
- **Last updated:** 06/09/2024