Healthcare Provider Details

I. General information

NPI: 1669347233
Provider Name (Legal Business Name): SAN GORGONIO MEMORIAL HEALTH CARE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N HIGHLAND SPRINGS AVE
BANNING CA
92220-3046
US

IV. Provider business mailing address

600 N HIGHLAND SPRINGS AVE
BANNING CA
92220-3046
US

V. Phone/Fax

Practice location:
  • Phone: 909-264-0246
  • Fax: 951-845-2836
Mailing address:
  • Phone: 909-264-0246
  • Fax: 951-845-2836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN PELEUSES
Title or Position: VP ANCILLARY AND SUPPORT SERVICES
Credential:
Phone: 909-264-0246