Healthcare Provider Details

I. General information

NPI: 1295778058
Provider Name (Legal Business Name): PINNACLE MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 03/21/2013
Certification Date:
Deactivation Date: 09/10/2009
Reactivation Date: 11/14/2012

III. Provider practice location address

1850 N RIVERSIDE AVE
RIALTO CA
92376-8071
US

IV. Provider business mailing address

PO BOX 12089
SAN BERNARDINO CA
92423-2089
US

V. Phone/Fax

Practice location:
  • Phone: 909-421-2700
  • Fax: 909-796-4158
Mailing address:
  • Phone: 909-335-4148
  • Fax: 909-796-4158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES SABBAH
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 909-881-4115