Healthcare Provider Details

I. General information

NPI: 1972079572
Provider Name (Legal Business Name): INLAND EMPIRE HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1384 N WATERMAN AVE
SAN BERNARDINO CA
92404-5313
US

IV. Provider business mailing address

1384 N WATERMAN AVE
SAN BERNARDINO CA
92404-5313
US

V. Phone/Fax

Practice location:
  • Phone: 909-252-7102
  • Fax: 909-677-2102
Mailing address:
  • Phone: 909-252-7102
  • Fax: 909-677-2102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: JEFFREY RYAN LANGDON
Title or Position: ADMINISTRATOR
Credential:
Phone: 909-936-9118