Organization
JARCO MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JECONIAS LOPEZ DEMIAR CRNA, RN, NA (MANAGER)
(909) 222-4779
Entity
Organization
Contact information
Practice address
12030 LA CADENA DR, GRAND TERRACE, CA 92313-3613
(909) 222-4779
(909) 222-4779
Mailing address
PO BOX M, LOMA LINDA, CA 92354-0556
(909) 222-4779
(909) 222-4779
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
RN160039
CA
Other
Enumeration date
04/01/2009
Last updated
05/19/2010
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