MEDICARE: RIVERSIDE FLETCHER MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center	A40329	CA

General Provider Information

NPI Number	:	1134412323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERSIDE FLETCHER MEDICAL GROUP

Provider Business Mailing Address
First Line	:	1915 W GLENOAKS BLVD # 101
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91201-1541
Country	:	US
Telephone Number	:	818-566-8305
Fax Number	:

Provider Business Practice Location Address
First Line	:	1915 W GLENOAKS BLVD # 101
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91201-1541
Country	:	US
Telephone Number	:	818-566-8305
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. ARTHUR VALLES
Credential	:	M.D.
Telephone Number	:	562-301-5306

Provider Enumeration Date	:	05/20/2011
Last Update Date	:	05/20/2011

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