| Lally Medical Group, A Professional Corporation | |
|
5050 San Bernardino St Montclair CA 91763-2326 | |
| (909) 464-8604 | |
| Not Available |
| Full Name | Lally Medical Group, A Professional Corporation |
|---|---|
| Speciality | Family Medicine |
| Location | 5050 San Bernardino St, Montclair, California |
| Authorized Official Name and Position | James M Lally (PRESIDENT) |
| Authorized Official Contact | 9094649675 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lally Medical Group, A Professional Corporation 5050 San Bernardino St Montclair CA 91763-2326 Ph: () - | Lally Medical Group, A Professional Corporation 5050 San Bernardino St Montclair CA 91763-2326 Ph: (909) 464-8604 |
| NPI Number | 1407306772 |
|---|---|
| Provider Enumeration Date | 10/10/2016 |
| Last Update Date | 01/03/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407306772 | NPI | - | NPPES |
| 1407306772 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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