Healthcare Provider Details

I. General information

NPI: 1295117299
Provider Name (Legal Business Name): INLAND FACULTY SPECIALISTS, A CALIFORNIA PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4153 RUBIDOUX AVE
RIVERSIDE CA
92506-1717
US

IV. Provider business mailing address

PO BOX 1762
COLTON CA
92324-0857
US

V. Phone/Fax

Practice location:
  • Phone: 951-384-7311
  • Fax: 951-342-3064
Mailing address:
  • Phone: 909-580-6333
  • Fax: 909-580-3289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number
License Number State

VIII. Authorized Official

Name: GUILLERMO J. VALENZUELA
Title or Position: PRESIDENT
Credential: MD
Phone: 909-580-6333