Provider Demographics
NPI:1073602314
Name:ARTHER MEDICAL GROUP
Entity Type:Organization
Organization Name:ARTHER MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:SONIA
Authorized Official - Last Name:ARTEAGA-HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-873-3876
Mailing Address - Street 1:851 W FOOTHILL BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-4731
Mailing Address - Country:US
Mailing Address - Phone:909-873-3876
Mailing Address - Fax:909-873-3875
Practice Address - Street 1:851 W FOOTHILL BLVD STE 101
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-4731
Practice Address - Country:US
Practice Address - Phone:909-873-3876
Practice Address - Fax:909-873-3875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63627207Q00000X
CAA50128208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A636270Medicaid
CA00A501280Medicaid
CA00A636271Medicare ID - Type Unspecified