Organization
LASALLE MEDICAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALBERT HENRY ARTEAGA M.D. (PRESIDENT)
(909) 890-0407
Entity
Organization
Contact information
Practice address
31762 MISSION TRAIL, SUITE F, LAKE ELSINORE, CA 92530
(951) 674-5686
(951) 674-4707
Mailing address
685 CARNEGIE DRIVE, SUITE 230, SAN BERNARDINO, CA 92408
(909) 890-0407
(909) 890-0575
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
—
GR0079094
—
CA
Enumeration date
03/02/2007
Last updated
08/22/2020
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