Healthcare Provider Details

I. General information

NPI: 1750529210
Provider Name (Legal Business Name): HEALTH GUARD INLAND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 01/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 MCARTHUR WAY
UPLAND CA
91786-5615
US

IV. Provider business mailing address

268 MCARTHUR WAY
UPLAND CA
91786-5615
US

V. Phone/Fax

Practice location:
  • Phone: 909-694-4020
  • Fax:
Mailing address:
  • Phone: 909-694-4020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MARINA ISOUNTS
Title or Position: PRESIDENT
Credential:
Phone: 909-694-4020