# ORTHOPAEDIC MEDICAL GROUP OF RIVERSIDE, INC.

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

## Provider details

- **NPI number:** 1477512671
- **Authorized official:** JUAN D GUAJARDO SR. (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (951) 774-4611

## Contact information

- **Practice address:** 6800 BROCKTON AVE, RIVERSIDE, CA 92506-3810
- **Practice address phone:** (951) 683-0650
- **Practice address fax:** (951) 276-3569
- **Mailing address:** 6800 BROCKTON AVE, SUITE 2, RIVERSIDE, CA 92506-3810
- **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 |

## Other

- **Enumeration date:** 03/17/2006
- **Last updated:** 03/17/2011