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General NPI Number Information
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NPI Number | 1316075062
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Entity Type | Organization
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Legal Business Name | LASALLE MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 08/23/2016
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Provider Practice Location Address
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Address Line | 16455 MAIN STREET SUITE 1
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City | HESPERIA
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State | CA
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Zip | 92345
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Country | US
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Telephone | 760-947-2161
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Fax | 760-947-3673
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Provider Business Mailing Address
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Address Line | 1855 W REDLANDS BLVD 2ND FLOOR
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City | REDLANDS
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State | CA
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Zip | 92373-3145
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Country | US
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Telephone | 909-890-0407
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Fax | 909-890-4597
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Authorized Official
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Title or Position | CEO/OWNER
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Name | ALBERT H. ATEAGA
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Credential | M.D.
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Telephone | 909-890-0407
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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 |
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License Number State |
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