Healthcare Provider Details

I. General information

NPI: 1255379764
Provider Name (Legal Business Name): CHRISTER A. JORETEG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 07/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 HIGHLAND SPRINGS AVE SUITE 200
BEAUMONT CA
92223
US

IV. Provider business mailing address

PO BOX 2200
REDLANDS CA
92373-0722
US

V. Phone/Fax

Practice location:
  • Phone: 951-845-0313
  • Fax: 909-796-4158
Mailing address:
  • Phone: 909-335-4188
  • Fax: 909-796-4158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA54456
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: