Provider Demographics
NPI:1689661522
Name:MEDICAL NETWORK RESOURCE CENTER, INC.
Entity type:Organization
Organization Name:MEDICAL NETWORK RESOURCE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-590-0797
Mailing Address - Street 1:13841 ROSWELL AVE
Mailing Address - Street 2:BLDG 12, UNIT I
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-5467
Mailing Address - Country:US
Mailing Address - Phone:909-590-0797
Mailing Address - Fax:909-590-5297
Practice Address - Street 1:13841 ROSWELL AVE
Practice Address - Street 2:BLDG 12, UNIT I
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-5467
Practice Address - Country:US
Practice Address - Phone:909-590-0797
Practice Address - Fax:909-590-5297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25737332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4352790001Medicare ID - Type Unspecified