Healthcare Provider Details

I. General information

NPI: 1467203695
Provider Name (Legal Business Name): CAJON MEDICAL GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2024
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 CALIFORNIA CITY BLVD
CALIFORNIA CITY CA
93505-2648
US

IV. Provider business mailing address

1809 W REDLANDS BLVD
REDLANDS CA
92373-8054
US

V. Phone/Fax

Practice location:
  • Phone: 909-289-4075
  • Fax: 909-363-8233
Mailing address:
  • Phone: 909-289-4075
  • Fax: 909-289-4075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AMBER GUTIERREZ
Title or Position: PROVIDER RELATIONS
Credential:
Phone: 909-289-4075