Healthcare Provider Details

I. General information

NPI: 1124317615
Provider Name (Legal Business Name): HOSPITALIST CORPORATION OF INLAND EMPIRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date: 04/26/2023
Reactivation Date: 05/24/2023

III. Provider practice location address

1880 N ORANGE GROVE AVE
POMONA CA
91767-3006
US

IV. Provider business mailing address

840 TOWNE CENTER DR
POMONA CA
91767-5900
US

V. Phone/Fax

Practice location:
  • Phone: 909-630-7158
  • Fax: 909-630-7983
Mailing address:
  • Phone: 909-398-1550
  • Fax: 909-398-1573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANGIE ALDARACA
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 909-236-7994