NPIMap

Organization Active NPI

Heritage Orthopedic & Industrial Medicine Multi-Specialty Group, Inc.

  • Orthopedic Chiropractor
  • San Bernardino, CA
National Provider Identifier
1730329285
Registry record updated Feb 24, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic ChiropractorTaxonomy code 111NX0800X
License
A85704 Issued in CA
Legal business name
HERITAGE ORTHOPEDIC & INDUSTRIAL MEDICINE MULTI-SPECIALTY GROUP, INC.
Practice address
1471 N Waterman Ave Ste 112
San Bernardino, CA 92404-5328
Phone
(909) 388-4660
NPI assigned
Feb 24, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2009

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

Authorized official

Name
Dr. Allen Fonseca, M.D.
Title
Medical Director
Phone
(818) 705-7200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NX0800X A85704 CA Primary

Addresses

Primary practice location

1471 N Waterman Ave Ste 112
San Bernardino, CA 92404-5328

Mailing address

17750 Sherman Way Ste 100
Reseda, CA 91335-8331
Phone (818) 705-7200

National Provider Directory

National Provider Directory
Tax ID family
Heritage Orthopedic Industrial Medicine Multi-Specialty Group Inc8 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

1471 N Waterman Ave
Ste 112
Sn Bernrdno, CA 92404
Phone (909) 388-4660

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1235433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235433600000",
    "number": "1730329285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17750 SHERMAN WAY STE 100",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913358331",
            "telephone_number": "818-705-7200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1471 N WATERMAN AVE STE 112",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924045328",
            "telephone_number": "909-388-4660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE ORTHOPEDIC & INDUSTRIAL MEDICINE MULTI-SPECIALTY GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-24",
        "last_updated": "2009-02-24",
        "status": "A",
        "authorized_official_last_name": "FONSECA",
        "authorized_official_first_name": "ALLEN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "818-705-7200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "111NX0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Orthopedic",
            "state": "CA",
            "license": "A85704",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Feb 24, 2009; 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.