Organization
CUCAMONGA VALLEY MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KYLE NELSON SMART D.O. (PRESIDENT)
(909) 429-2864
Entity
Organization
Contact information
Practice address
16465 SIERRA LAKES PARKWAY, #300, FONTANA, CA 92336
(909) 429-2864
(909) 429-2868
Mailing address
16465 SIERRA LAKES PARKWAY, #300, FONTANA, CA 92336
(909) 429-2864
(909) 429-2868
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
858582
ME
Other
Enumeration date
06/29/2006
Last updated
04/29/2013
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