MEDICARE: SAN BERNARDINO MEDICAL ORTHOPAEDIC GROUP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1225770100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN BERNARDINO MEDICAL ORTHOPAEDIC GROUP, INC.

Provider Business Mailing Address
First Line	:	1801 ORANGE TREE LN STE 240
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92374-4587
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	41990 COOK ST STE 302
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-6101
Country	:	US
Telephone Number	:	909-557-1600
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JOHN PIRONTI
Credential	:
Telephone Number	:	909-557-1600

Provider Enumeration Date	:	04/11/2022
Last Update Date	:	09/05/2024

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