NPIMap

Organization Active NPI

Neonatology Medical Group Inc

  • Family Medicine Physician
  • Fontana, CA
National Provider Identifier
1851404693
Registry record updated Aug 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
NEONATOLOGY MEDICAL GROUP INC
Practice address
17264 Foothill Blvd
Ste a B
Fontana, CA 92335-9051
Phone
(909) 428-3900
Fax
(909) 428-3903
NPI assigned
Aug 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2008

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

Authorized official

Name
Mrs. Grace Escobal Muraligopal
Title
Chief Financial Officer
Phone
(909) 790-5071

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Adult Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0505X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Neonatal-Perinatal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080N0001X

Addresses

Primary practice location

17264 Foothill Blvd
Ste a B
Fontana, CA 92335-9051

Mailing address

PO Box 8188
Redlands, CA 92375-1388
Phone (909) 790-5071

Other identifiers 1

IdentifierTypeStateIssuer
GR0004461MedicaidCA

Other names 1

  • Fontana Family Medical Center Doing business as

National Provider Directory

National Provider Directory

Locations

17264 Foothill Blvd
Ste Ab
Fontana, CA 92335
Phone (909) 428-3900

Practitioners & affiliated clinicians

Practitioners 6

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": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218585600000",
    "number": "1851404693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8188",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923751388",
            "telephone_number": "909-790-5071",
            "fax_number": "909-790-5774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17264 FOOTHILL BLVD",
            "address_2": "STE A B",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923359051",
            "telephone_number": "909-428-3900",
            "fax_number": "909-428-3903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEONATOLOGY MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-16",
        "last_updated": "2008-08-13",
        "status": "A",
        "authorized_official_last_name": "MURALIGOPAL",
        "authorized_official_first_name": "GRACE",
        "authorized_official_middle_name": "ESCOBAL",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "909-790-5071",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0004461",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fontana Family Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fontana, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2008; 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.