Provider Demographics
NPI:1326134586
Name:RIALTO FAMILY MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:RIALTO FAMILY MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:BALLAINE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:909-421-9576
Mailing Address - Street 1:1786 N RIVERSIDE AVE
Mailing Address - Street 2:#1
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-8059
Mailing Address - Country:US
Mailing Address - Phone:909-421-9576
Mailing Address - Fax:909-421-0711
Practice Address - Street 1:1786 N RIVERSIDE AVE
Practice Address - Street 2:#1
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-8059
Practice Address - Country:US
Practice Address - Phone:909-421-9576
Practice Address - Fax:909-421-0711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty