Healthcare Provider Details

I. General information

NPI: 1235318445
Provider Name (Legal Business Name): INLAND HEALTHCARE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7430 CHERRY AVE STE 110
FONTANA CA
92336-4255
US

IV. Provider business mailing address

1980 ORANGE TREE LN STE 200
REDLANDS CA
92374-4550
US

V. Phone/Fax

Practice location:
  • Phone: 909-350-4624
  • Fax: 909-357-1160
Mailing address:
  • Phone: 909-335-7171
  • Fax: 909-335-7139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LISA PERKO
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 909-335-7171