Healthcare Provider Details

I. General information

NPI: 1700063625
Provider Name (Legal Business Name): INLAND EMPIRE MEDICAL NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 WEST BASELINE ROAD
CLAREMONT CA
91711-1696
US

IV. Provider business mailing address

840 TOWNE CENTER DRIVE
POMONA CA
91767-5900
US

V. Phone/Fax

Practice location:
  • Phone: 909-770-8640
  • Fax: 909-770-8650
Mailing address:
  • Phone: 909-398-1550
  • Fax: 909-398-1573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: ROBERT THOMAS ROCCO
Title or Position: MD/PRESIDENT
Credential: MD
Phone: 909-621-3916