Healthcare Provider Details

I. General information

NPI: 1144317512
Provider Name (Legal Business Name): INLAND PODIATRY GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4049 ALMOND ST SUITE 101
RIVERSIDE CA
92501-3531
US

IV. Provider business mailing address

4049 ALMOND ST SUITE 101
RIVERSIDE CA
92501-3531
US

V. Phone/Fax

Practice location:
  • Phone: 951-781-3660
  • Fax: 951-781-3661
Mailing address:
  • Phone: 951-781-3660
  • Fax: 951-781-3661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JEREMY ALLEN BUSCH
Title or Position: PRESIDENT
Credential: DPM
Phone: 951-781-3660