Healthcare Provider Details

I. General information

NPI: 1962568501
Provider Name (Legal Business Name): WOMEN'S MEDICAL GROUP OF UPLAND INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8263 GROVE AVE STE 204
RANCHO CUCAMONGA CA
91730-3107
US

IV. Provider business mailing address

8263 GROVE AVE STE 204
RANCHO CUCAMONGA CA
91730-3107
US

V. Phone/Fax

Practice location:
  • Phone: 909-931-1033
  • Fax: 909-981-8976
Mailing address:
  • Phone: 909-931-1033
  • Fax: 909-981-8976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA00041400
License Number StateCA

VIII. Authorized Official

Name: ROBIN BAYLESS
Title or Position: OFFICE MANAGER
Credential:
Phone: 909-931-1033