Healthcare Provider Details

I. General information

NPI: 1780681189
Provider Name (Legal Business Name): SAN ANTONIO REGIONAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 SAN BERNARDINO RD
UPLAND CA
91786-4920
US

IV. Provider business mailing address

999 SAN BERNARDINO RD
UPLAND CA
91786-4920
US

V. Phone/Fax

Practice location:
  • Phone: 909-985-2811
  • Fax: 909-949-1774
Mailing address:
  • Phone: 909-985-2811
  • Fax: 909-949-1774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number240000196
License Number StateCA

VIII. Authorized Official

Name: MR. WAH-CHUNG HSU
Title or Position: V.P. FINANCE/CFO
Credential:
Phone: 909-920-6103