Provider Demographics
NPI:1689855975
Name:PRISTINE MEDICAL GROUP
Entity Type:Organization
Organization Name:PRISTINE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GABRIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-629-0444
Mailing Address - Street 1:1890 N GAREY AVE
Mailing Address - Street 2:SUITE #B
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2923
Mailing Address - Country:US
Mailing Address - Phone:909-626-0444
Mailing Address - Fax:909-629-0446
Practice Address - Street 1:1890 N GAREY AVE
Practice Address - Street 2:SUITE #B
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2923
Practice Address - Country:US
Practice Address - Phone:909-626-0444
Practice Address - Fax:909-629-0446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty