David E Engelhardt MD Inc

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

G63529 Issued in CA

Legal business name

DAVID E ENGELHARDT MD INC

Practice address

631 N 13TH Ave Ste B
Upland, CA 91786-4964

Phone

(909) 931-3838

Fax

(909) 931-3349

NPI assigned

Jan 5, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

David Edward Engelhardt, MD

Title

President

Phone

(909) 931-3838

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1231113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547683200000",
    "number": "1295971778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "631 N 13TH AVE STE B",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864964",
            "telephone_number": "909-931-3838",
            "fax_number": "909-931-3349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "631 N 13TH AVE STE B",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864964",
            "telephone_number": "909-931-3838",
            "fax_number": "909-931-3349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID E ENGELHARDT MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-05",
        "last_updated": "2019-01-17",
        "status": "A",
        "authorized_official_last_name": "ENGELHARDT",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-931-3838",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "G63529",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G635290",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Upland, CA
• Providers in Upland, CA by specialty
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.