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General NPI Number Information
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NPI Number | 1730707951
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Entity Type | Organization
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Legal Business Name | CAJON MEDICAL GROUP PC
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Dates
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Enumeration Date | 07/14/2020
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Last Update Date | 07/14/2020
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Provider Practice Location Address
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Address Line | 4013 BROCKTON AVE
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City | RIVERSIDE
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State | CA
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Zip | 92501-3440
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Country | US
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Telephone | 951-300-8124
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Fax | 951-262-7720
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Provider Business Mailing Address
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Address Line | 1809 W REDLANDS BLVD
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City | REDLANDS
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State | CA
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Zip | 92373-8054
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Country | US
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Telephone | 909-289-4075
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Fax | 909-363-8233
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MONIQUE HUGUES
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Credential |
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Telephone | 951-500-2121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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