Healthcare Provider Details

I. General information

NPI: 1982533709
Provider Name (Legal Business Name): SKYLINE MEDICAL ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 E 11TH ST STE 102
UPLAND CA
91786-4872
US

IV. Provider business mailing address

811 E 11TH ST STE 102
UPLAND CA
91786-4872
US

V. Phone/Fax

Practice location:
  • Phone: 840-228-2648
  • Fax: 909-377-5302
Mailing address:
  • Phone: 840-228-2648
  • Fax: 909-377-5302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROMEO SAMOUH
Title or Position: OWNER
Credential: MD
Phone: 840-228-2648