Organization
PHOENIX MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENT PRATELY MD (ORTHOPEDIC)
(951) 687-6600
Entity
Organization
Contact information
Practice address
3576 ARLINGTON AVE, SUITE 100, RIVERSIDE, CA 92506-3943
(951) 687-6600
(951) 687-6601
Mailing address
3576 ARLINGTON AVE, SUITE 100, RIVERSIDE, CA 92506-3943
(951) 687-6600
(951) 687-6601
Taxonomy
Speciality
Code
Description
License number
State
111NX0800X
Orthopedic Chiropractor
Primary
—
—
171100000X
Acupuncturist
—
—
225100000X
Physical Therapist
—
—
Other
Enumeration date
07/24/2013
Last updated
07/24/2013
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