Healthcare Provider Details

I. General information

NPI: 1821601840
Provider Name (Legal Business Name): GASTRO HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 10/11/2026
Certification Date: 10/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1895 ORANGE TREE LN STE 102
REDLANDS CA
92374-0112
US

IV. Provider business mailing address

11234 ANDERSON ST RM 2586A
LOMA LINDA CA
92350-1716
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-2600
  • Fax:
Mailing address:
  • Phone: 909-558-7884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: TINA NOBLE MACOMBER
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 909-558-7884