Malcolm Glen Corp

Primary specialty

Hearing Instrument SpecialistTaxonomy code 237700000X

License

HA3682 Issued in CA

Legal business name

MALCOLM GLEN CORP

Practice address

528 No Palm Ave
Ontario, CA 91762-3218

Phone

(909) 986-9635

Fax

(909) 391-5873

NPI assigned

Aug 4, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Gary M Jones, HIS

Title

Cfo

Phone

(909) 986-9635

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Miracle Ear Ontario Doing business as

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1861400780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "528 NO PALM AVE",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917623218",
            "telephone_number": "909-986-9635",
            "fax_number": "909-391-5873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "528 NO PALM AVE",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917623218",
            "telephone_number": "909-986-9635",
            "fax_number": "909-391-5873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MALCOLM GLEN CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "909-986-9635",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "HIS"
    },
    "taxonomies": [
        {
            "code": "237700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Hearing Instrument Specialist",
            "state": "CA",
            "license": "HA3682",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ04705Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HA0036820",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Miracle Ear Ontario",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alexia Mailloux
• Nancy Maina
• Michael Maines, COTA/L
• Khanti Makda
• Valerie Malagon
• Alberto Maldonado, BCBA
• Valerie Maldonado, BACHELORS DEGREE
• Adam Malik, DO
• Ansar Mahmood Malik, MBBS
• Pauline Monique a Mallari, PHARMD

• Hearing Instrument Specialist in Ontario, CA
• Providers in Ontario, CA by specialty
• Hearing Instrument Specialist 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.