Healthcare Provider Details

I. General information

NPI: 1952728750
Provider Name (Legal Business Name): INTERNATIONAL PHYSICIANS MANAGEMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22911 CREST FOREST DRIVE
CRESTLINE CA
92325-1139
US

IV. Provider business mailing address

PO BOX 1139
CRESTLINE CA
92325-1139
US

V. Phone/Fax

Practice location:
  • Phone: 909-338-9882
  • Fax: 909-338-9883
Mailing address:
  • Phone: 909-338-9882
  • Fax: 909-338-9883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JANET STEARS
Title or Position: PRESIDENT
Credential:
Phone: 909-338-9882