# ORTHOPAEDIC MEDICAL GROUP OF RIVERSIDE, INC.

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

## Provider details

- **NPI number:** 1083626048
- **Authorized official:** MR. JUAN D GUAJARDO (CHIEF EXCUTIVE OFFICER)
- **Authorized official phone:** (951) 774-4611

## Contact information

- **Practice address:** 29099 HOSPITAL ROAD, SUITE 112, LAKE ARROWHEAD, CA 92352
- **Practice address phone:** (909) 337-9300
- **Practice address fax:** (909) 337-6440
- **Mailing address:** 6850 BROCKTON AVE, SUITE 212, RIVERSIDE, CA 92506-3808
- **Mailing address phone:** (951) 774-4611
- **Mailing address fax:** (951) 276-3597

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | C42773 | CA | Yes |

## Other

- **Enumeration date:** 08/11/2006
- **Last updated:** 03/05/2008