Organization
LASALLE MEDICAL ASSOCIATES
Active
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
565 N. MT. VERNON AVE., SAN BERNARDINO, CA 92411-2661
(909) 884-9091
(909) 383-7013
Mailing address
1855 W REDLANDS BLVD, 2ND FLOOR, REDLANDS, CA 92373-3145
(909) 890-0407
(909) 890-0575
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
A31849
CA
261QM1300X
Multi-Specialty Clinic/Center
Primary
A38206
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A382060
MEDI-CAL ID NUMBER
CA
05
—
GR0079095
—
CA
01
—
P00014299
RR MEDICARE PIN
CA
Enumeration date
03/01/2007
Last updated
08/23/2016
Update your record
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