Montclair Vida Health Clinic PC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

License

20A8311 Issued in CA

Legal business name

MONTCLAIR VIDA HEALTH CLINIC PC

Practice address

5404 Moreno St
Suite N&P
Montclair, CA 91763

Phone

(909) 949-4400

Fax

(909) 949-4441

NPI assigned

May 8, 2012

Organization subpart

No

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

Authorized official

Name

Ginger L Leon, D.O.NPI 1245234780

Title

Medical Director

Phone

(909) 949-4400

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ginger Lina Leon, D.O.

  • Family Medicine Physician
  • Montclair, CA
  • NPI 1245234780
  Medicare reassignment NPD Authorized official
• Martin Madrigal, PA-C

  • Medical Physician Assistant
  • Montclair, CA
  • NPI 1043371636
  Medicare reassignment
• Krystal Yasmeen Camacho

  • Physician Assistant
  • Montclair, CA
  • NPI 1649981721
  NPD (past)
• Aurora Galvan

  • Family Nurse Practitioner
  • Montclair, CA
  • NPI 1386337228
  NPD (past)
• Manjot Hundal, PA-C

  • Physician Assistant
  • Montclair, CA
  • NPI 1992301832
  NPD (past)
• Sultana Ikramullah, M.D.

  • Psychiatry Physician
  • Covina, CA
  • NPI 1326065210
  NPD (past)
• Deborah Ann Kass, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • San Francisco, CA
  • NPI 1043323611
  NPD (past)
• Robert William McAlister Jr., PSY.D

  • Clinical Psychologist
  • Carlsbad, CA
  • NPI 1699009308
  NPD (past)
• Vinod Chandrashekhar Patwardhan, M.D

  • Hematology & Oncology Physician
  • Montclair, CA
  • NPI 1114922606
  NPD (past)
• Susan Christine Barrett, PSY.D.

  • Psychologist
  • Nampa, ID
  • NPI 1740471192
  NPD (past)
• Marsha Kay Burgess, CRNP

  • Nurse Practitioner
  • Birmingham, AL
  • NPI 1891746699
  NPD (past)

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

{
    "created_epoch": "1336435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528329600000",
    "number": "1699034827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5404 MORENO ST",
            "address_2": "SUITE N&P",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "917631667",
            "telephone_number": "909-949-4400",
            "fax_number": "909-949-4441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5404 MORENO ST",
            "address_2": "SUITE N&P",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "91763",
            "telephone_number": "909-949-4400",
            "fax_number": "909-949-4441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTCLAIR VIDA HEALTH CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-08",
        "last_updated": "2018-06-07",
        "status": "A",
        "authorized_official_last_name": "LEON",
        "authorized_official_first_name": "GINGER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "909-949-4400",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "CA",
            "license": "20A8311",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Montclair Medical Professional Corporation
• Montclair MRI Inc.
• Montclair Plaza Dental Group
• Montclair Royale Senior Living
• Montclair Ultrasound Health Center, Inc.
• Monte Vista Child Care Center Inc
• Monte Vista Child Care Center Inc
• Monte Vista Medical Group, Inc.
• Jazzmin Montenegro
• Alda Christina Montes

• Health Service Clinic/Center in Montclair, CA
• Providers in Montclair, CA by specialty
• Health Service Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.