Organization
HERITAGE ORTHOPEDIC & INDUSTRIAL MEDICINE MULTI-SPECIALTY GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALLEN FONSECA M.D. (MEDICAL DIRECTOR)
(818) 705-7200
Entity
Organization
Contact information
Practice address
1471 N WATERMAN AVE STE 112, SAN BERNARDINO, CA 92404-5328
(909) 388-4660
Mailing address
17750 SHERMAN WAY STE 100, RESEDA, CA 91335-8331
(818) 705-7200
Taxonomy
Speciality
Code
Description
License number
State
111NX0800X
Orthopedic Chiropractor
Primary
A85704
CA
Other
Enumeration date
02/24/2009
Last updated
02/24/2009
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