NPIMap

Organization Active NPI

Lasalle Medical Associates

  • Multi-Specialty Clinic/Center
  • San Bernardino, CA
National Provider Identifier
1548398142
Registry record updated Aug 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
LASALLE MEDICAL ASSOCIATES
Practice address
1505 W. 17TH Street
San Bernardino, CA 92411
Phone
(909) 887-6494
Fax
(909) 887-6043
NPI assigned
Mar 2, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2016

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

Authorized official

Name
Mr. Albert H. Arteaga, M.D.
Title
Ceo/Owner
Phone
(909) 890-0407

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

1505 W. 17TH Street
San Bernardino, CA 92411

Mailing address

1855 W Redlands Blvd
2ND Floor
Redlands, CA 92373-3145
Phone (909) 890-0407

Other identifiers 2

IdentifierTypeStateIssuer
GR0079091MedicaidCA
00A382060OtherCAMEDI-CAL ID NUMBER

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0575267Lasalle Medical Associates 17TH St1505 W 17TH Street, San Bernardino, CA 92411Certificate of waiverApr 25, 2027

National Provider Directory

National Provider Directory
Tax ID family
Lasalle Medical Associates7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

NPI Registry JSON

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

{
    "created_epoch": "1172793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471910400000",
    "number": "1548398142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1855 W REDLANDS BLVD",
            "address_2": "2ND FLOOR",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923733145",
            "telephone_number": "909-890-0407",
            "fax_number": "909-890-0575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 W. 17TH STREET",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "92411",
            "telephone_number": "909-887-6494",
            "fax_number": "909-887-6043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LASALLE MEDICAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-02",
        "last_updated": "2016-08-23",
        "status": "A",
        "authorized_official_last_name": "ARTEAGA",
        "authorized_official_first_name": "ALBERT",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "909-890-0407",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0079091",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL ID NUMBER",
            "identifier": "00A382060",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Aug 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.