Organization
CLINICA MEDICA FAMILIAR-PHN, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ESTEBAN GUERRERO III MBA (C.O.O)
(951) 429-4086
Entity
Organization
Contact information
Practice address
280 N RIVERSIDE AVE, RIALTO, CA 92376-5924
(909) 421-2121
(909) 421-0491
Mailing address
9792 SIERRA AVE, FONTANA, CA 92335-6717
(909) 434-6000
(909) 434-6001
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GR0082770
MEDI-CAL PROVIDER NUMBER
CA
Enumeration date
04/09/2007
Last updated
05/08/2024
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