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Organization
LALLY MEDICAL GROUP, A PROFESSIONAL CORPORATION
Active
Organization
LALLY MEDICAL GROUP, A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES M LALLY DO (PRESIDENT)
(909) 464-9675
Entity
Organization
Contact information
Practice address
5050 SAN BERNARDINO ST, MONTCLAIR, CA 91763-2326
(909) 464-8604
Mailing address
5050 SAN BERNARDINO ST, MONTCLAIR, CA 91763-2326
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407306772
—
CA
Enumeration date
10/10/2016
Last updated
01/03/2018
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