Organization
PRIMARY PEDIATRIC AND ADOLESCENT CLINIC, INCORPORATED
Active
Other names
Haven Family Medical Center, Incorporated
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. FALAHYAH MOKHTAR (OFFICE MANAGER)
(909) 466-8888
Entity
Organization
Contact information
Practice address
8599 HAVEN AVE, STE. 101, RANCHO CUCAMONGA, CA 91730-4849
(909) 466-8888
(909) 483-0164
Mailing address
8599 HAVEN AVE, STE. 101, RANCHO CUCAMONGA, CA 91730-4849
(909) 466-8888
(909) 483-0164
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
A33327
CA
Other
Enumeration date
11/06/2006
Last updated
08/22/2020
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