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Organization
ORTHOPAEDIC MEDICAL GROUP OF RIVERSIDE, INC.
Active
Organization
ORTHOPAEDIC MEDICAL GROUP OF RIVERSIDE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUAN D GUAJARDO (CEO)
(951) 774-4611
Entity
Organization
Contact information
Practice address
6850 BROCKTON AVE, SUITE 212, RIVERSIDE, CA 92506-3808
(951) 774-4611
(951) 276-3597
Mailing address
6850 BROCKTON AVE, SUITE 212, RIVERSIDE, CA 92506-3808
(951) 774-4611
(951) 276-3597
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
PSY 11922
CA
207X00000X
Orthopaedic Surgery Physician
Primary
—
NULL
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
A69385
CA
225100000X
Physical Therapist
—
NULL
225100000X
Physical Therapist
—
—
Other
Enumeration date
03/05/2008
Last updated
03/05/2008
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