Healthcare Provider Details

I. General information

NPI: 1093843005
Provider Name (Legal Business Name): ARROWHEAD PEDIATRICS MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N PEPPER AVE
COLTON CA
92324
US

IV. Provider business mailing address

400 N PEPPER AVE # 2MOB203
COLTON CA
92324-1801
US

V. Phone/Fax

Practice location:
  • Phone: 909-580-3380
  • Fax: 909-580-6361
Mailing address:
  • Phone: 909-580-3380
  • Fax: 909-580-6361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WEBSTER ANDREW WONG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 909-580-3380