Healthcare Provider Details

I. General information

NPI: 1831033893
Provider Name (Legal Business Name): ICON MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 TERRACINA BLVD
REDLANDS CA
92373-4850
US

IV. Provider business mailing address

1690 BARTON RD STE 106
REDLANDS CA
92373-4230
US

V. Phone/Fax

Practice location:
  • Phone: 909-936-0600
  • Fax:
Mailing address:
  • Phone: 909-936-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SAMIR HAGE
Title or Position: PRESIDENT
Credential: DO
Phone: 909-936-0600