NPIMap

Organization Active NPI

San Marcos Medical Group Inc.

Doing business as metropolitan family medical clinic

  • Family Nurse Practitioner
  • San Bernardino, CA
National Provider Identifier
1184674830
Registry record updated Apr 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
SAN MARCOS MEDICAL GROUP INC.
Doing business as
metropolitan family medical clinic
Practice address
1574 W Base Line St
San Bernardino, CA 92411-1736
Phone
(909) 881-7320
Fax
(909) 881-7330
NPI assigned
May 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2022

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

Authorized official

Name
Sandra Gonzalez
Title
Coordinator
Phone
(909) 376-4438

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X Primary

Addresses

Primary practice location

1574 W Base Line St
San Bernardino, CA 92411-1736

Mailing address

1574 W Base Line St
San Bernardino, CA 92411-1736
Phone (909) 881-7320

Other identifiers 2

IdentifierTypeStateIssuer
1295384428MedicaidCA
CA482046OtherCAMEDICARE

Other names 1

  • metropolitan family medical clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Metropolitan Family Medical Clinic8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

7965 Sierra Ave
Fontana, CA 92336
Phone (909) 356-4459

10444 Live Oak Ave
Fontana, CA 92337

7965 Sierra Ave
Ste E
Fontana, CA 92336
Phone (909) 356-4459

742 W Highland Ave
#C
San Bernardino, CA 92405

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651190400000",
    "number": "1184674830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1574 W BASE LINE ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924111736",
            "telephone_number": "909-881-7320",
            "fax_number": "909-881-7330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1574 W BASE LINE ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924111736",
            "telephone_number": "909-881-7320",
            "fax_number": "909-881-7330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN MARCOS MEDICAL GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-11",
        "last_updated": "2022-04-29",
        "certification_date": "2022-04-29",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_title_or_position": "COORDINATOR",
        "authorized_official_telephone_number": "909-376-4438"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1295384428",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "CA482046",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "metropolitan family medical clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "metropolitan family medical clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Bernardino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2022; 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.