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General NPI Number Information
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NPI Number | 1134412323
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Entity Type | Organization
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Legal Business Name | RIVERSIDE FLETCHER MEDICAL GROUP
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Dates
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Enumeration Date | 05/20/2011
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Last Update Date | 05/20/2011
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Provider Practice Location Address
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Address Line | 1915 W GLENOAKS BLVD # 101
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City | GLENDALE
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State | CA
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Zip | 91201-1541
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Country | US
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Telephone | 818-566-8305
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Fax |
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Provider Business Mailing Address
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Address Line | 1915 W GLENOAKS BLVD # 101
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City | GLENDALE
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State | CA
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Zip | 91201-1541
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Country | US
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Telephone | 818-566-8305
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ARTHUR VALLES
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Credential | M.D.
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Telephone | 562-301-5306
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | A40329
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License Number State | CA
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