Primary Pediatric and Adolescent Clinic, Incorporated

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

A33327 Issued in CA

Legal business name

PRIMARY PEDIATRIC AND ADOLESCENT CLINIC, INCORPORATED

Doing business as

Haven Family Medical Center, Incorporated

Practice address

8599 Haven Ave
Ste. 101
Rancho Cucamonga, CA 91730-4849

Phone

(909) 466-8888

Fax

(909) 483-0164

NPI assigned

Nov 6, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Falahyah Mokhtar

Title

Office Manager

Phone

(909) 466-8888

Specialties & licenses 1

Addresses

Other names 1

• Haven Family Medical Center, Incorporated Doing business as

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1326117516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8599 HAVEN AVE",
            "address_2": "STE. 101",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917304849",
            "telephone_number": "909-466-8888",
            "fax_number": "909-483-0164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8599 HAVEN AVE",
            "address_2": "STE. 101",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917304849",
            "telephone_number": "909-466-8888",
            "fax_number": "909-483-0164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY PEDIATRIC AND ADOLESCENT CLINIC, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOKHTAR",
        "authorized_official_first_name": "FALAHYAH",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "909-466-8888",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "CA",
            "license": "A33327",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Haven Family Medical Center, Incorporated",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Preferred Provider Organization in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• Preferred Provider Organization in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.