Healthcare Provider Details

I. General information

NPI: 1346961109
Provider Name (Legal Business Name): BEDSIDE MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 E 21ST ST STE K
SAN BERNARDINO CA
92404-4851
US

IV. Provider business mailing address

256 ALVARADO ST
REDLANDS CA
92373-5121
US

V. Phone/Fax

Practice location:
  • Phone: 909-800-3892
  • Fax:
Mailing address:
  • Phone: 909-800-3892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TYLER MISKIN
Title or Position: OWNER
Credential: MD
Phone: 909-800-3892