Healthcare Provider Details

I. General information

NPI: 1093838765
Provider Name (Legal Business Name): HEALTH EDUCATORS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 E HIGHLAND AVE STE 110
SAN BERNARDINO CA
92404-3842
US

IV. Provider business mailing address

399 E HIGHLAND AVE STE 110
SAN BERNARDINO CA
92404-3842
US

V. Phone/Fax

Practice location:
  • Phone: 909-881-7623
  • Fax:
Mailing address:
  • Phone: 909-881-7623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberG40250
License Number StateCA

VIII. Authorized Official

Name: IRVING L SPRATT
Title or Position: OWNER
Credential: MD
Phone: 909-881-7623