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General NPI Number Information
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NPI Number | 1922954544
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Entity Type | Organization
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Legal Business Name | ALTA VIDA MEDICAL GROUP INC
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Dates
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Enumeration Date | 03/06/2026
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Last Update Date | 03/06/2026
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Provider Practice Location Address
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Address Line | 363 S INDIAN HILL BLVD
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City | CLAREMONT
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State | CA
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Zip | 91711-5224
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Country | US
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Telephone | 909-816-7927
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Fax |
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Provider Business Mailing Address
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Address Line | 12326 MERITAGE CT
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739-8825
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GEORGE MORAN
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Credential | MD
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Telephone | 909-816-7927
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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