# ALTA MEDICAL CLINIC INC OF CALIFORNIA

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

## Provider details

- **NPI number:** 1316661549
- **Authorized official:** PETERSON GO (PRESIDENT)
- **Authorized official phone:** (909) 236-0338

## Contact information

- **Practice address:** 9836 FOOTHILL BLVD STE 610, RANCHO CUCAMONGA, CA 91730-3660
- **Practice address phone:** (909) 236-0338
- **Mailing address:** 9836 FOOTHILL BLVD STE 610, RANCHO CUCAMONGA, CA 91730-3660
- **Mailing address phone:** (909) 236-0338

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084B0040X | Behavioral Neurology & Neuropsychiatry Physician | — | NULL | — |
| 2084B0040X | Behavioral Neurology & Neuropsychiatry Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/30/2022
- **Last updated:** 09/30/2022