# LAS PALMAS MEDICAL GROUP CORP.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013214568
- **Authorized official:** IRMA LOPEZ M.D. (OWNER)
- **Authorized official phone:** (909) 391-3448

## Contact information

- **Practice address:** 602 N EUCLID AVE, SUITE A, ONTARIO, CA 91762-3224
- **Practice address phone:** (909) 391-3448
- **Mailing address:** 602 N EUCLID AVE, SUITE A, ONTARIO, CA 91762-3224
- **Mailing address phone:** (909) 391-3448

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | G57022 | CA | Yes |

## Other

- **Enumeration date:** 02/18/2011
- **Last updated:** 02/18/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1164503652 | — | CA |
| 05 | — | 1770663551 | — | CA |