Provider Demographics
NPI:1942398482
Name:ARTEAGA, ALBERT HENRY (MD)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:HENRY
Last Name:ARTEAGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 CARNEGIE DR.
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3583
Mailing Address - Country:US
Mailing Address - Phone:909-890-0407
Mailing Address - Fax:909-890-0575
Practice Address - Street 1:17577 ARROW BLVD
Practice Address - Street 2:
Practice Address - City:FONTAN
Practice Address - State:CA
Practice Address - Zip Code:92335
Practice Address - Country:US
Practice Address - Phone:909-823-4454
Practice Address - Fax:909-823-6918
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38206208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A382060OtherMEDI-CAL
CA00A382060OtherMEDI-CAL