Organization
LASALLE MEDICAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALBERT H. ATEAGA M.D. (CEO/OWNER)
(909) 890-0407
Entity
Organization
Contact information
Practice address
16455 MAIN STREET, SUITE 1, HESPERIA, CA 92345
(760) 947-2161
(760) 947-3673
Mailing address
1855 W REDLANDS BLVD, 2ND FLOOR, 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
—
GR0079092
—
CA
01
—
P00226162
RAILROAD MEDICARE UPIN
CA
Enumeration date
03/02/2007
Last updated
08/23/2016
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