Organization
ORTHOPAEDIC MEDICAL GROUP OF RIVERSIDE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUAN D. GUAJARDO (CHIEF EXECUTIVE OFFICER)
(951) 774-4611
Entity
Organization
Contact information
Practice address
399 E HIGHLAND AVE, SUITE 409, SAN BERNARDINO, CA 92404-3808
(951) 774-4611
(951) 276-3597
Mailing address
6850 BROCKTON AVE, SUITE 212, RIVERSIDE, CA 92506-3808
(951) 774-4611
(951) 276-3597
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
Other
Enumeration date
08/18/2006
Last updated
09/26/2008
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