Healthcare Provider Details

I. General information

NPI: 1174760953
Provider Name (Legal Business Name): INLAND HEALTHCARE GROUP A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2009
Last Update Date: 05/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17051 SIERRA LAKES PKWY SUITE 101
FONTANA CA
92336-1274
US

IV. Provider business mailing address

PO BOX 10488
SAN BERNARDINO CA
92423-0488
US

V. Phone/Fax

Practice location:
  • Phone: 909-428-2040
  • Fax: 909-428-2191
Mailing address:
  • Phone: 888-344-9111
  • Fax: 909-335-7130

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 Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CAREY PAUL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 909-335-7171