Healthcare Provider Details

I. General information

NPI: 1093650004
Provider Name (Legal Business Name): INLAND PSYCHIATRIC MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

556 MOWRY AVE STE 100
FREMONT CA
94536-4186
US

IV. Provider business mailing address

556 MOWRY AVE STE 100
FREMONT CA
94536-4186
US

V. Phone/Fax

Practice location:
  • Phone: 510-839-1888
  • Fax: 510-248-2516
Mailing address:
  • Phone: 510-839-1888
  • Fax: 510-248-2516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: AMBER GUTIERREZ
Title or Position: PROVIDER RELATIONS ADMIN
Credential:
Phone: 909-289-4075