Healthcare Provider Details

I. General information

NPI: 1386699171
Provider Name (Legal Business Name): MARIA F PLODKOWSKI PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E REDLAND BLVD SUITE 215 INLAND PSYCHIATRIC MEDICAL GROUP INC
REDLANDS CA
92373
US

IV. Provider business mailing address

101 E REDLAND BLVD SUITE 234
REDLANDS CA
92373
US

V. Phone/Fax

Practice location:
  • Phone: 909-335-3026
  • Fax: 909-335-3167
Mailing address:
  • Phone: 909-335-3026
  • Fax: 909-335-3167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY18657
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: