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Organization
OG MOBILE MEDICAL GROUP
Active
Organization
OG MOBILE MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE CLARK-POVEDA PA (OWNER)
(909) 274-9143
Entity
Organization
Contact information
Practice address
8972 APPALOOSA CT, RANCHO CUCAMONGA, CA 91737-1401
(909) 274-9143
(909) 294-5911
Mailing address
PO BOX 8896, ALTA LOMA, CA 91701-0896
(909) 274-9143
(909) 295-5911
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
208D00000X
General Practice Physician
—
—
363A00000X
Physician Assistant
—
—
Other
Enumeration date
01/30/2023
Last updated
01/30/2023
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