Healthcare Provider Details

I. General information

NPI: 1073602314
Provider Name (Legal Business Name): ARTHER MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 03/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 W FOOTHILL BLVD STE 101
RIALTO CA
92376-4731
US

IV. Provider business mailing address

851 W FOOTHILL BLVD STE 101
RIALTO CA
92376-4731
US

V. Phone/Fax

Practice location:
  • Phone: 909-873-3876
  • Fax: 909-873-3875
Mailing address:
  • Phone: 909-873-3876
  • Fax: 909-873-3875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA50128
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA63627
License Number StateCA

VIII. Authorized Official

Name: EDNA SONIA ARTEAGA-HERNANDEZ
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 909-873-3876