# OPTUM CARE NETWORK-INLAND FACULTY MG

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

## Provider details

- **NPI number:** 1750455713
- **Authorized official:** VALDEMAR LUCATERO (IPA-OPERATIONS MANAGER)
- **Authorized official phone:** (909) 815-4702

## Contact information

- **Practice address:** 952 S MOUNT VERNON AVE STE B, COLTON, CA 92324-4224
- **Practice address phone:** (909) 433-9111
- **Practice address fax:** (909) 433-9199
- **Mailing address:** 952 S MOUNT VERNON AVE STE B, COLTON, CA 92324-4224

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | 44334241 | CA | Yes |

## Other

- **Enumeration date:** 11/20/2006
- **Last updated:** 06/29/2022