1356511349 NPI number — INLAND OB/GYN ASSOCIATES, A MEDICAL CORPORATION

Table of content: (NPI 1356511349)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356511349 NPI number — INLAND OB/GYN ASSOCIATES, A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INLAND OB/GYN ASSOCIATES, A MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356511349
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10488
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN BERNARDINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92423-0488
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-335-7171
Provider Business Mailing Address Fax Number:
909-335-7130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7430 CHERRY AVE
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
FONTANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92336-4255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-350-4620
Provider Business Practice Location Address Fax Number:
909-854-5920
Provider Enumeration Date:
03/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SCHAUERMANN
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
909-882-4605

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1528018488 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1356511349 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0090610 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1538119318 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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