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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
MR. JUAN D. GUAJARDO (CHIEF EXECUTIVE OFFICER)
(951) 774-4611
Entity
Organization
Contact information
Practice address
399 E HIGHLAND AVE, SUITE 409, SAN BERNARDINO, CA 92404-3808
(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
207X00000X
Orthopaedic Surgery Physician
Primary
—
NULL
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
—
—
Other
Enumeration date
08/18/2006
Last updated
09/26/2008
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