Jarco Medical Group, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

RN160039 Issued in CA

Legal business name

JARCO MEDICAL GROUP, LLC

Practice address

12030 La Cadena Dr
Grand Terrace, CA 92313-3613

Phone

(909) 222-4779

Fax

(909) 222-4779

NPI assigned

Apr 1, 2009

Organization subpart

No

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

Authorized official

Name

Mr. Jeconias Lopez Demiar, CRNA, RN, NA

Title

Manager

Phone

(909) 222-4779

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1238544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274227200000",
    "number": "1770725939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX M",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923540556",
            "telephone_number": "909-222-4779",
            "fax_number": "909-222-4779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12030 LA CADENA DR",
            "city": "GRAND TERRACE",
            "state": "CA",
            "postal_code": "923133613",
            "telephone_number": "909-222-4779",
            "fax_number": "909-222-4779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JARCO MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-01",
        "last_updated": "2010-05-19",
        "status": "A",
        "authorized_official_last_name": "DEMIAR",
        "authorized_official_first_name": "JECONIAS",
        "authorized_official_middle_name": "LOPEZ",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "909-222-4779",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CRNA, RN, NA"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": "RN160039",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Grand Terrace, CA
• Providers in Grand Terrace, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2010; 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.