Organization
SAN MARCOS MEDICAL GROUP
Active
Other names
METROPOLITAN INDUSTRIAL MEDICAL CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
AZER REZK (ADMINISTRATOR)
(909) 376-7715
Entity
Organization
Contact information
Practice address
10444 LIVEOAK AVE., FONTANA, CA 92337-7219
(909) 770-8293
(909) 770-8298
Mailing address
10444 LIVEOAK AVE., FONTANA, CA 92337-7219
(909) 770-8293
(909) 770-8298
Taxonomy
Speciality
Code
Description
License number
State
261QX0100X
Occupational Medicine Clinic/Center
Primary
A040591
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A045091
MEDICAL LISCENCE
CA
Enumeration date
02/15/2007
Last updated
08/22/2020
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