# ORTHOPAEDIC MEDICAL GROUP OF RIVERSIDE, INC.

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

## Provider details

- **NPI number:** 1316051261
- **Authorized official:** MR. JUAN D. GUAJARDO (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (951) 774-4611

## Contact information

- **Practice address:** 399 E HIGHLAND AVE, SUITE 409, SAN BERNARDINO, CA 92404-3808
- **Practice address phone:** (951) 774-4611
- **Practice address fax:** (951) 276-3597
- **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 | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | — |

## Other

- **Enumeration date:** 08/18/2006
- **Last updated:** 09/26/2008