Healthcare Provider Details

I. General information

NPI: 1659110203
Provider Name (Legal Business Name): CARE LOBBY MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9329 MARIPOSA RD
HESPERIA CA
92344-8000
US

IV. Provider business mailing address

9329 MARIPOSA RD
HESPERIA CA
92344-8000
US

V. Phone/Fax

Practice location:
  • Phone: 760-905-6097
  • Fax:
Mailing address:
  • Phone: 760-905-6097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALAVA MARSH
Title or Position: CEO/OWNER
Credential: MD
Phone: 760-905-6097