Orthopaedic Medical Group of Riverside, Inc.

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

C42773 Issued in CA

Legal business name

ORTHOPAEDIC MEDICAL GROUP OF RIVERSIDE, INC.

Practice address

29099 Hospital Road
Suite 112
Lake Arrowhead, CA 92352

Phone

(909) 337-9300

Fax

(909) 337-6440

NPI assigned

Aug 11, 2006

Last updated

Mar 5, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Juan D Guajardo

Title

Chief Excutive Officer

Phone

(951) 774-4611

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204675200000",
    "number": "1083626048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6850 BROCKTON AVE",
            "address_2": "SUITE 212",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925063808",
            "telephone_number": "951-774-4611",
            "fax_number": "951-276-3597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29099 HOSPITAL ROAD",
            "address_2": "SUITE 112",
            "city": "LAKE ARROWHEAD",
            "state": "CA",
            "postal_code": "92352",
            "telephone_number": "909-337-9300",
            "fax_number": "909-337-6440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOPAEDIC MEDICAL GROUP OF RIVERSIDE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-11",
        "last_updated": "2008-03-05",
        "status": "A",
        "authorized_official_last_name": "GUAJARDO",
        "authorized_official_first_name": "JUAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CHIEF EXCUTIVE OFFICER",
        "authorized_official_telephone_number": "951-774-4611",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "C42773",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mountain Healthcare Inc (986 Pharmacy #8031)
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• Desma S Nikas
• Jan Ochs, RDHAP
• Robert M Olson III, M.D.
• Pamela Osborn, DPT
• Elizabeth Paganini, MA, CCC-SLP
• Michele Lee Pereira, LVN
• Richard Rankin, PH.D.
• Darren Ream, DPT

• Orthopaedic Surgery Physician in Lake Arrowhead, CA
• Providers in Lake Arrowhead, CA by specialty
• Orthopaedic Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.