Provider Demographics
NPI:1821749755
Name:SAN BERNARDINO MEDICAL ORTHOPAEDIC GROUP INC.
Entity Type:Organization
Organization Name:SAN BERNARDINO MEDICAL ORTHOPAEDIC GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOTERIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-557-1605
Mailing Address - Street 1:1801 ORANGE TREE LN STE 240
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4587
Mailing Address - Country:US
Mailing Address - Phone:909-800-2813
Mailing Address - Fax:
Practice Address - Street 1:835 HIGHLAND SPRINGS AVENUE
Practice Address - Street 2:SUITE 210
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223
Practice Address - Country:US
Practice Address - Phone:909-557-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty