Provider Demographics
NPI:1104706456
Name:RANCHO PRIMARY CARE CLINIC, A NURSING PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:RANCHO PRIMARY CARE CLINIC, A NURSING PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LOVELLA
Authorized Official - Middle Name:CANTOS
Authorized Official - Last Name:DELOS SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:951-315-2646
Mailing Address - Street 1:9619 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3507
Mailing Address - Country:US
Mailing Address - Phone:909-360-1885
Mailing Address - Fax:
Practice Address - Street 1:9619 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3507
Practice Address - Country:US
Practice Address - Phone:909-360-1885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty