Facts
- Status
- A
- Type
- Organization
- Enumeration date
- 2005-07-05
- Last updated
- 2020-08-22
Licenses
- License CA
- 240000086
- License CA
- 250000756
- License CA
- 250000807
- License CA
- 080000150
Location
- Practice location
- 18601 VALLEY BLVD
- City
- BLOOMINGTON CA
- Postal code
- 923161831
- Phone
- 909-877-1818
Organization contact
- Name
- BOBBY VASCOVICH
- Title
- Chief Executive Officer
- Phone
- 9098771818
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.