Gateway Medicor - Rancho Cucamonga Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

GATEWAY MEDICOR - RANCHO CUCAMONGA INC.

Practice address

10995 Eucalyptus St Ste 102
Rancho Cucamonga, CA 91730-7687

Phone

(800) 708-3230

NPI assigned

Nov 21, 2023

Last updated

Feb 14, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Robert Elders

Title

Secretary

Phone

(714) 788-1249

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

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Amg, a Professional Medical Corporation

  • Internal Medicine Physician
  • Alhambra, CA
  • NPI 1558306266

  Member Of

  NPD member
• Medicor Medical Group, Inc

  • Family Medicine Physician
  • Rancho Cucamonga, CA
  • NPI 1790863819

  Member Of

  NPD member

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Johnny Demetria Dauz III, FNP-C

  • Family Nurse Practitioner
  • Upland, CA
  • NPI 1528342607
  Medicare reassignment Care Compare group NPD
• Heather Sue Nenadovic, FNP

  • Family Nurse Practitioner
  • Rancho Cucamonga, CA
  • NPI 1477378230
  Medicare reassignment Care Compare group NPD
• Mark L Shiu, DO

  • Family Medicine Physician
  • Rancho Cucamonga, CA
  • NPI 1629004478
  Medicare reassignment Care Compare group NPD
• Georgina Mendoza, FNP

  • Family Nurse Practitioner
  • Rancho Cucamonga, CA
  • NPI 1295593929
  NPD (past)

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

{
    "created_epoch": "1700524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707868800000",
    "number": "1932974896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 CITY PKWY W FL 10",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928682968",
            "telephone_number": "800-708-3230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10995 EUCALYPTUS ST STE 102",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917307687",
            "telephone_number": "800-708-3230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GATEWAY MEDICOR - RANCHO CUCAMONGA INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-21",
        "last_updated": "2024-02-14",
        "certification_date": "2024-02-14",
        "status": "A",
        "authorized_official_last_name": "ELDERS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "714-788-1249"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cadence Gassaway
• Crystal Gastelum
• Rosemary Gastelum
• Joseph Bryan Jovito Francisco Gatchalian, RPT
• Blair Renee Gates, DPT
• Rheanne Madison Gatmaitan, DMD
• William Randolph Gause, N.P.
• Analy Gaytan
• Carlos Joel Gaytan, LCSW
• Jennifer Gaytan

• Family Medicine Physician in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2024; 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.