Organization
COSENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARLISE NEGRETTE (ACCOUNT MANAGER)
(909) 793-5511
Entity
Organization
Contact information
Practice address
401 E 21ST ST, SAN BERNARDINO, CA 92404-4845
(909) 881-3333
Mailing address
6627 MURRIETTA CT, RANCHO CUCAMONGA, CA 91739-9556
(909) 793-5511
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
06/29/2021
Last updated
09/23/2024
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