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Organization
JARCO MEDICAL GROUP, LLC
Active
Organization
JARCO MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JECONIAS LOPEZ DEMIAR CRNA, RN, NA (MANAGER)
(909) 222-4779
Entity
Organization
Contact information
Practice address
12030 LA CADENA DR, GRAND TERRACE, CA 92313-3613
(909) 222-4779
(909) 222-4779
Mailing address
PO BOX M, LOMA LINDA, CA 92354-0556
(909) 222-4779
(909) 222-4779
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
RN160039
CA
Other
Enumeration date
04/01/2009
Last updated
05/19/2010
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