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Organization
SAN MARCOS MEDICAL GROUP INC.
Active
Organization
SAN MARCOS MEDICAL GROUP INC.
Active
Other names
metropolitan family medical clinic
Organization subpart
No
Provider details
NPI number
Authorized official
SANDRA GONZALEZ (COORDINATOR)
(909) 376-4438
Entity
Organization
Contact information
Practice address
1574 W BASE LINE ST, SAN BERNARDINO, CA 92411-1736
(909) 881-7320
(909) 881-7330
Mailing address
1574 W BASE LINE ST, SAN BERNARDINO, CA 92411-1736
(909) 881-7320
(909) 881-7330
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1295384428
—
CA
01
—
CA482046
MEDICARE
CA
Enumeration date
05/11/2006
Last updated
04/29/2022
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