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Organization
NEONATOLOGY MEDICAL GROUP INC
Active
Organization
NEONATOLOGY MEDICAL GROUP INC
Active
Other names
Fontana Family Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GRACE ESCOBAL MURALIGOPAL (CHIEF FINANCIAL OFFICER)
(909) 790-5071
Entity
Organization
Contact information
Practice address
17264 FOOTHILL BLVD, STE A B, FONTANA, CA 92335-9051
(909) 428-3900
(909) 428-3903
Mailing address
PO BOX 8188, REDLANDS, CA 92375-1388
(909) 790-5071
(909) 790-5774
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207QA0505X
Adult Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
2080N0001X
Neonatal-Perinatal Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0004461
—
CA
Enumeration date
08/16/2006
Last updated
08/13/2008
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