1750153417 NPI number — INLAND FACIAL TRAUMA, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750153417 NPI number — INLAND FACIAL TRAUMA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INLAND FACIAL TRAUMA, INC
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:
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:
1750153417
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
INLAND FACIAL TRAUMA, INC
Provider Second Line Business Mailing Address:
39755 MURRIETA HOT SPRINGS, B120
Provider Business Mailing Address City Name:
MURRIETA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-600-7457
Provider Business Mailing Address Fax Number:
951-327-9554

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
INLAND VALLEY MEDICAL CENTER
Provider Second Line Business Practice Location Address:
36485 INLAND VALLEY DRIVE
Provider Business Practice Location Address City Name:
WILDOMAR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92595
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-600-7457
Provider Business Practice Location Address Fax Number:
951-327-9554
Provider Enumeration Date:
10/26/2023

Additional Information

Authorized Official

Authorized Official Last Name:
PULSIPHER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
951-600-7457

Provider Taxonomy Codes

  • Taxonomy code: 204E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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