| Organization Name: | JARCO MEDICAL GROUP, LLC |
| NPI Number: | 1770725939 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JECONIAS LOPEZ DEMIAR (MANAGER) |
| Mailing Address: | 12030 La Cadena Dr Grand Terrace |
| State: | CA US |
| Postal Code: | 923133613 |
| Phone Number: | 9092224779 |
| Fax Number: | 9092224779 |
| NPI Enumeration Date: | 04/01/2009 |
| NPI Last Update Date: | 05/19/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | RN160039 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |