Organization
KAISER FONTANA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NOC PHAM MDA (DIRECTOR)
(909) 427-5000
Entity
Organization
Contact information
Practice address
9961 SIERRA AVE, FONTANA, CA 92335-6720
(801) 791-4514
Mailing address
1607 INDEPENDENCE AVE, REDLANDS, CA 92374
(801) 791-4514
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
806523
CA
284300000X
Special Hospital
Primary
806523
CA
Other
Enumeration date
07/18/2014
Last updated
07/18/2014
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