Organization
LASALLE MEDICAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALBERT H. ARTEAGA M.D. (CEO/OWNER)
(909) 890-0407
Entity
Organization
Contact information
Practice address
17577 ARROW BLVD, FONTANA, CA 92335
(909) 823-4454
(909) 823-6918
Mailing address
1855 W REDLANDS BLVD FL 2, REDLANDS, CA 92373-3145
(909) 890-0407
(909) 890-4597
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A382060
MEDI-CAL ID NUMBER
CA
05
—
GR0079090
—
CA
Enumeration date
03/01/2007
Last updated
01/21/2020
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