Organization
OPTUM CARE NETWORK-INLAND FACULTY MG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VALDEMAR LUCATERO (IPA-OPERATIONS MANAGER)
(909) 815-4702
Entity
Organization
Contact information
Practice address
952 S MOUNT VERNON AVE STE B, COLTON, CA 92324-4224
(909) 433-9111
(909) 433-9199
Mailing address
952 S MOUNT VERNON AVE STE B, COLTON, CA 92324-4224
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
44334241
CA
Other
Enumeration date
11/20/2006
Last updated
06/29/2022
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