Healthcare Provider Details

I. General information

NPI: 1205127941
Provider Name (Legal Business Name): INLAND EMPIRE DIAGNOSTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2011
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77711 FLORA RD STE 110
PALM DESERT CA
92211-4103
US

IV. Provider business mailing address

77711 FLORA RD STE 110
PALM DESERT CA
92211-4103
US

V. Phone/Fax

Practice location:
  • Phone: 760-507-1156
  • Fax: 800-490-0801
Mailing address:
  • Phone: 760-507-1156
  • Fax: 800-490-0801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. KRISTOFER KISNER
Title or Position: OWNER
Credential:
Phone: 951-454-2673