Organization
ALTA MEDICAL CLINIC INC OF CALIFORNIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETERSON GO (PRESIDENT)
(909) 236-0338
Entity
Organization
Contact information
Practice address
9836 FOOTHILL BLVD STE 610, RANCHO CUCAMONGA, CA 91730-3660
(909) 236-0338
Mailing address
9836 FOOTHILL BLVD STE 610, RANCHO CUCAMONGA, CA 91730-3660
(909) 236-0338
Taxonomy
Speciality
Code
Description
License number
State
2084B0040X
Behavioral Neurology & Neuropsychiatry Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
09/30/2022
Last updated
09/30/2022
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