| Lasalle Medical Associates | |
|
17577 Arrow Blvd Fontana CA 92335 | |
| (909) 823-4454 | |
| (909) 823-6918 |
| Full Name | Lasalle Medical Associates |
|---|---|
| Speciality | Clinic/Center |
| Location | 17577 Arrow Blvd, Fontana, California |
| Authorized Official Name and Position | Albert H. Arteaga (CEO/OWNER) |
| Authorized Official Contact | 9098900407 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lasalle Medical Associates 1855 W Redlands Blvd Fl 2 Redlands CA 92373-3145 Ph: (909) 890-0407 | Lasalle Medical Associates 17577 Arrow Blvd Fontana CA 92335 Ph: (909) 823-4454 |
| NPI Number | 1275661084 |
|---|---|
| Provider Enumeration Date | 03/01/2007 |
| Last Update Date | 01/21/2020 |
| Medicare PECOS PAC ID | 1557301744 |
|---|---|
| Medicare Enrollment ID | O20050506000376 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275661084 | NPI | - | NPPES |
| GR0079090 | Medicaid | CA | |
| 00A382060 | Other | CA | MEDI-CAL ID NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Jennifer J Dsa |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750510251 PECOS PAC ID: 0648423475 Enrollment ID: I20130103000410 |
| Provider Name | Melinda Funk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679560346 PECOS PAC ID: 2769606623 Enrollment ID: I20140616000809 |
| Provider Name | Jim Y Wu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285605014 PECOS PAC ID: 7012006265 Enrollment ID: I20150428001013 |
| Provider Name | Andrew Benin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548758006 PECOS PAC ID: 5294133104 Enrollment ID: I20211007000585 |
| Provider Name | Nooshin Salehi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1053802470 PECOS PAC ID: 7810375235 Enrollment ID: I20220525002215 |
| Provider Name | Silvestre Hernandez Mendoza |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215627195 PECOS PAC ID: 4082061726 Enrollment ID: I20231116003646 |
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