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Organization

LAS PALMAS MEDICAL GROUP CORP.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
IRMA LOPEZ M.D. (OWNER)
(909) 391-3448
Entity
Organization

Contact information

Practice address
602 N EUCLID AVE, SUITE A, ONTARIO, CA 91762-3224
(909) 391-3448
Mailing address
602 N EUCLID AVE, SUITE A, ONTARIO, CA 91762-3224
(909) 391-3448

Taxonomy

Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
G57022
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1164503652
CA
05
1770663551
CA
Enumeration date
02/18/2011
Last updated
02/18/2011
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