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Organization
INTERNAL MEDICINE MEDICAL GROUP
Active
Organization
INTERNAL MEDICINE MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ADRIENNE MARIE WALKER (CONTRACTS MANAGER)
(909) 398-1550
Entity
Organization
Contact information
Practice address
1866 N ORANGE GROVE AVE, SUITE 102, POMONA, CA 91767-3031
(909) 865-0676
(909) 865-8483
Mailing address
840 TOWNE CENTER DRIVE, POMONA, CA 91767-3031
(909) 398-1550
(909) 398-1573
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0011290
—
CA
Enumeration date
06/06/2007
Last updated
10/15/2007
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