Healthcare Provider Details

I. General information

NPI: 1295077295
Provider Name (Legal Business Name): HOSPITALIST CORPORATION OF INLAND EMPIRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2013
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date: 04/26/2023
Reactivation Date: 05/24/2023

III. Provider practice location address

9190 HAVEN AVE FL 1
RANCHO CUCAMONGA CA
91730-5431
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: 909-398-1488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PRAVEENA JEEREDDI
Title or Position: PRESIDENT
Credential: MD
Phone: 909-398-1550