Healthcare Provider Details

I. General information

NPI: 1144423468
Provider Name (Legal Business Name): INTERNAL MEDICINE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10837 LAUREL AVENUE INTERNAL MEDICINE MEDICAL GROUP SUITE 104
RANCHO CUCAMONGA CA
91730-7643
US

IV. Provider business mailing address

840 TOWNE CENTER DRIVE INTERNAL MEDICINE MEDICAL GROUP
POMONA CA
91767-5900
US

V. Phone/Fax

Practice location:
  • Phone: 909-581-6732
  • Fax: 909-581-6737
Mailing address:
  • Phone: 909-398-1500
  • Fax: 909-398-1573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ADRIENNE MARIE WALKER
Title or Position: CONTRACTS MANAGER
Credential:
Phone: 909-398-1550