Organization
MONTCLAIR VIDA HEALTH CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GINGER L LEON D.O. (MEDICAL DIRECTOR)
(909) 949-4400
Entity
Organization
Contact information
Practice address
5404 MORENO ST, SUITE N&P, MONTCLAIR, CA 91763
(909) 949-4400
(909) 949-4441
Mailing address
5404 MORENO ST, SUITE N&P, MONTCLAIR, CA 91763-1667
(909) 949-4400
(909) 949-4441
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
20A8311
CA
Other
Enumeration date
05/08/2012
Last updated
06/07/2018
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