Healthcare Provider Details

I. General information

NPI: 1376876912
Provider Name (Legal Business Name): PINNACLE MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8110 MANGO AVE
FONTANA CA
92335-3603
US

IV. Provider business mailing address

P.O. BOX 12209
SAN BERNARDINO CA
92424-2209
US

V. Phone/Fax

Practice location:
  • Phone: 909-427-1303
  • Fax:
Mailing address:
  • Phone: 909-357-1595
  • Fax: 909-357-1203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. CHARLES S SABBAH
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 909-357-1595