Healthcare Provider Details

I. General information

NPI: 1861702359
Provider Name (Legal Business Name): INLAND OUTPATIENT SURGERY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 10/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4217 LUTHER ST
RIVERSIDE CA
92506-2853
US

IV. Provider business mailing address

41670 IVY ST SUITE B
MURRIETA CA
92562-9432
US

V. Phone/Fax

Practice location:
  • Phone: 951-600-7702
  • Fax: 951-600-5935
Mailing address:
  • Phone: 951-600-7702
  • Fax: 951-600-5935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW THIO
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 951-600-7702