Healthcare Provider Details

I. General information

NPI: 1356557581
Provider Name (Legal Business Name): INLAND PODIATRY CENTER PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 04/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9474 BASELINE RD
ALTA LOMA CA
91701-5822
US

IV. Provider business mailing address

9474 BASELINE RD
ALTA LOMA CA
91701-5822
US

V. Phone/Fax

Practice location:
  • Phone: 909-987-3211
  • Fax: 909-987-0317
Mailing address:
  • Phone: 909-987-3211
  • Fax: 909-987-0317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE1457
License Number StateCA

VIII. Authorized Official

Name: DR. WILLIAM C. LANDREY
Title or Position: OWNER,PODIATRIST
Credential: D.P.M.
Phone: 909-987-3211