Provider Demographics
NPI:1003845876
Name:CALIFORNIA FOOTHILLS MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:CALIFORNIA FOOTHILLS MEDICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:IRA
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-945-2425
Mailing Address - Street 1:8211 ROCHESTER AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3903
Mailing Address - Country:US
Mailing Address - Phone:909-945-2425
Mailing Address - Fax:909-948-6971
Practice Address - Street 1:8211 ROCHESTER AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3903
Practice Address - Country:US
Practice Address - Phone:909-945-2425
Practice Address - Fax:909-948-6971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD37547Medicare UPIN
CAZZZ23109ZMedicare ID - Type Unspecified