1447388251 NPI number — LASALLE MEDICAL ASSOCIATES

Table of content: (NPI 1447388251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447388251 NPI number — LASALLE MEDICAL ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LASALLE MEDICAL ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447388251
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1855 W REDLANDS BLVD
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
REDLANDS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92373-3145
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-890-0407
Provider Business Mailing Address Fax Number:
909-890-0575

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
565 N. MT. VERNON AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN BERNARDINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92411-2661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-884-9091
Provider Business Practice Location Address Fax Number:
909-383-7013
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ARTEAGA
Authorized Official First Name:
ALBERT
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
CEO/OWNER
Authorized Official Telephone Number:
909-890-0407

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X , with the licence number: A38206 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM1300X , with the licence number: A31849 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00014299 . This is a "RR MEDICARE PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A382060 . This is a "MEDI-CAL ID NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0079095 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00014299 . This is a "RAILROAD MEDICARE UPIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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