Organization · NPI-2

M. Jay Porcelli DO A Medical Corporation

Family Medicine, Geriatric Medicine · Pomona, CA

NPI number1679998694
StatusActive
Last updated in NPPESMar 11, 2014

Details

NPI
1679998694
Entity type
Organization (NPI-2)
Legal business name
M. Jay Porcelli DO A Medical Corporation
Organization subpart
No
Enumeration date
Feb 27, 2014
Last updated
Mar 11, 2014

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207QG0300X Family Medicine, Geriatric Medicine20A4403CAYes
208VP0000X 20A4403CA

Practice location

336 Ervilla St
Pomona, CA 91767-3016

Phone 909-620-1955 · Fax 909-623-0720

Mailing address

336 Ervilla St
Pomona, CA 91767-3016

Phone 909-620-1955 · Fax 909-623-0720

Authorized official

Martin Jay Porcelli
Ceo & President
9096201955

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