Healthcare Provider Details

I. General information

NPI: 1043654593
Provider Name (Legal Business Name): INLAND MOBILE DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2013
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12810 SIERRA CREEK DR
RIVERSIDE CA
92503-8466
US

IV. Provider business mailing address

12810 SIERRA CREEK DR
RIVERSIDE CA
92503-8466
US

V. Phone/Fax

Practice location:
  • Phone: 951-288-4709
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number710
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: ELYAS KHURY
Title or Position: CEO
Credential:
Phone: 951-288-4709