Healthcare Provider Details

I. General information

NPI: 1619600574
Provider Name (Legal Business Name): INLAND EMPIRE OBGYN REGISTRY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 SAN BERNARDINO RD STE 201
UPLAND CA
91786-4985
US

IV. Provider business mailing address

1310 SAN BERNARDINO RD STE 201
UPLAND CA
91786-4985
US

V. Phone/Fax

Practice location:
  • Phone: 909-579-0806
  • Fax: 909-579-1331
Mailing address:
  • Phone: 909-579-0806
  • Fax: 909-579-1331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: FRANKLIN JOHNSON
Title or Position: CEO
Credential: D.O.
Phone: 909-579-0806