Alta Medical Group of California

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

ALTA MEDICAL GROUP OF CALIFORNIA

Practice address

9836 Foothill Blvd Ste 610
Rancho Cucamonga, CA 91730-3660

Phone

(909) 236-0338

NPI assigned

Oct 3, 2022

Organization subpart

No

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

Authorized official

Name

Peterson Go

Title

President

Phone

(909) 236-0338

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1664755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664755200000",
    "number": "1508580523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9836 FOOTHILL BLVD STE 610",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917303660",
            "telephone_number": "909-236-0338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9836 FOOTHILL BLVD STE 610",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917303660",
            "telephone_number": "909-236-0338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTA MEDICAL GROUP OF CALIFORNIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-03",
        "last_updated": "2022-10-03",
        "certification_date": "2022-10-03",
        "status": "A",
        "authorized_official_last_name": "GO",
        "authorized_official_first_name": "PETERSON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-236-0338"
    },
    "taxonomies": [
        {
            "code": "2084B0040X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 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.