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General NPI Number Information
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NPI Number | 1730994906
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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 | 02/12/2025
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 17310 BEAR VALLEY RD STE B101
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City | VICTORVILLE
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State | CA
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Zip | 92395-7773
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Country | US
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Telephone | 909-735-2446
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Fax | 909-206-1553
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Provider Business Mailing Address
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Address Line | 1815 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 | PROVIDER RELATIONS MANAGER
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Name | AMBER GUTIERREZ
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Credential |
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Telephone | 909-289-4075
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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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