Organization
CENTRAL OCCUPATIONAL MEDICINE PROVIDERS - ONTARIO, A MEDICAL CORPORATI
Active
Other names
COMP
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREGORY JOSEPH SPEER (ADMINISTRATOR)
(951) 222-2206
Entity
Organization
Contact information
Practice address
295 E CAROLINE ST, SUITE D-1, SAN BERNARDINO, CA 92408-3700
(909) 723-1161
(909) 723-1168
Mailing address
4300 CENTRAL AVE, RIVERSIDE, CA 92506-2918
(951) 222-2206
(951) 222-2196
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
20A5982
CA
207Q00000X
Family Medicine Physician
A43039
CA
207Q00000X
Family Medicine Physician
A48324
CA
207R00000X
Internal Medicine Physician
A48512
CA
208D00000X
General Practice Physician
20A9190
CA
208D00000X
General Practice Physician
G70519
CA
208D00000X
General Practice Physician
G72529
CA
261QX0100X
Occupational Medicine Clinic/Center
Primary
—
—
363AM0700X
Medical Physician Assistant
PA52001
CA
Other
Enumeration date
05/02/2012
Last updated
04/14/2015
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