Alta Medical Group Of California
General Practice in Rancho Cucamonga, CA. Organization (NPI-2).
NPI number1508580523
StatusActive
Last updated in NPPESOct 3, 2022
Details
- NPI
- 1508580523
- Entity type
- Organization (NPI-2)
- Legal business name
- Alta Medical Group Of California
- Organization subpart
- No
- Enumeration date
- Oct 3, 2022
- Certification date
- Oct 3, 2022
- Last updated
- Oct 3, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208D00000X | General Practice | – | – | Yes |
| 2084B0040X | Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry | – | – |
Practice location
9836 Foothill Blvd Ste 610Rancho Cucamonga, CA 91730-3660
Phone 909-236-0338
Mailing address
9836 Foothill Blvd Ste 610Rancho Cucamonga, CA 91730-3660
Phone 909-236-0338
Authorized official
Peterson Go
President
9092360338
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