Healthcare Provider Details

I. General information

NPI: 1194282095
Provider Name (Legal Business Name): HOSPITALIST CORPORATION OF INLAND EMPIRE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date: 04/26/2023
Reactivation Date: 05/24/2023

III. Provider practice location address

5385 WALNUT AVE STE 4
CHINO CA
91710-2605
US

IV. Provider business mailing address

840 TOWNE CENTER DRIVE
POMONA CA
91767-5900
US

V. Phone/Fax

Practice location:
  • Phone: 909-620-7200
  • Fax: 909-620-5800
Mailing address:
  • Phone: 909-398-1550
  • Fax: 909-398-1488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: PRAVEENA JEEREDDI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 909-398-1500