# ORTHOPAEDIC MEDICAL GROUP OF RIVERSIDE, INC.

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

## Provider details

- **NPI number:** 1013576180
- **Authorized official:** CHRISTY DEMERS DO (CREDENTIALING)
- **Authorized official phone:** (951) 683-0650

## Contact information

- **Practice address:** 1800 WESTERN AVE STE 106, SAN BERNARDINO, CA 92411-1352
- **Practice address phone:** (951) 683-0650
- **Practice address fax:** (951) 774-4612
- **Mailing address:** 4354 LATHAM ST STE 100, RIVERSIDE, CA 92501-1777
- **Mailing address phone:** (951) 683-0650
- **Mailing address fax:** (951) 774-4612

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/11/2019
- **Last updated:** 06/11/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZZ40607Z | — | CA |