# ALTAIS MEDICAL GROUP - RIVERSIDE, INC.

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

## Provider details

- **NPI number:** 1518629575
- **Authorized official:** MAURICIO EDUARDO BUENO (DIRECTOR/PRESIDENT)
- **Authorized official phone:** (323) 791-0557

## Contact information

- **Practice address:** 4646 BROCKTON AVE STE 201, RIVERSIDE, CA 92506-0104
- **Practice address phone:** (626) 840-1359
- **Mailing address:** 4646 BROCKTON AVE STE 201, RIVERSIDE, CA 92506-0104
- **Mailing address phone:** (951) 585-1800
- **Mailing address fax:** (951) 585-1801

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/07/2021
- **Last updated:** 03/31/2026