Organization
LASALLE MEDICAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALBERT H. ARTEAGA M.D. (CEO/OWNER)
(909) 890-0407
Entity
Organization
Contact information
Practice address
1505 W. 17TH STREET, SAN BERNARDINO, CA 92411
(909) 887-6494
(909) 887-6043
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
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A382060
MEDI-CAL ID NUMBER
CA
05
—
GR0079091
—
CA
Enumeration date
03/02/2007
Last updated
08/23/2016
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