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NPI Code Detail

MEDICARE: ORTHOPAEDIC MEDICAL GROUP OF RIVERSIDE, INC.

MEDICARE: ORTHOPAEDIC MEDICAL GROUP OF RIVERSIDE, 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
1207X00000XOrthopaedic Surgery Physician

General Provider Information

NPI Number : 1477512671
Entity Type Code : Organization
Provider Name (Legal Business Name) : ORTHOPAEDIC MEDICAL GROUP OF RIVERSIDE, INC.
Provider Business Mailing Address
First Line : 6800 BROCKTON AVE
Second Line : SUITE 2
City : RIVERSIDE
State : CA
Zip : 92506-3810
Country : US
Telephone Number : 951-774-4611
Fax Number : 951-276-3597
Provider Business Practice Location Address
First Line : 6800 BROCKTON AVE
Second Line :
City : RIVERSIDE
State : CA
Zip : 92506-3810
Country : US
Telephone Number : 951-683-0650
Fax Number : 951-276-3569
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : JUAN D GUAJARDO SR.
Credential :
Telephone Number : 951-774-4611
Provider Enumeration Date : 03/17/2006
Last Update Date : 03/17/2011

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