| Lasalle Medical Associates | |
|
16455 Main Street Suite 1 Hesperia CA 92345 | |
| (760) 947-2161 | |
| (760) 947-3673 |
| Full Name | Lasalle Medical Associates |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 16455 Main Street, Hesperia, California |
| Authorized Official Name and Position | Albert H. Ateaga (CEO/OWNER) |
| Authorized Official Contact | 9098900407 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lasalle Medical Associates 1855 W Redlands Blvd 2nd Floor Redlands CA 92373-3145 Ph: (909) 890-0407 | Lasalle Medical Associates 16455 Main Street Suite 1 Hesperia CA 92345 Ph: (760) 947-2161 |
| NPI Number | 1316075062 |
|---|---|
| Provider Enumeration Date | 03/02/2007 |
| Last Update Date | 08/23/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316075062 | NPI | - | NPPES |
| GR0079092 | Medicaid | CA | |
| 00A382060 | Other | CA | MEDI-CAL ID NUMBER |
| P00226162 | Other | CA | RAILROAD MEDICARE UPIN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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