Healthcare Provider Details

I. General information

NPI: 1316219868
Provider Name (Legal Business Name): REDLANDS YUCAIPA MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2012
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33423 YUCAIPA BLVD SUITE D
YUCAIPA CA
92399-2064
US

IV. Provider business mailing address

33423 YUCAIPA BLVD SUITE D
YUCAIPA CA
92399-2064
US

V. Phone/Fax

Practice location:
  • Phone: 909-790-7070
  • Fax:
Mailing address:
  • Phone: 909-790-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: WALTER JONES III
Title or Position: PRESIDENT
Credential: MD
Phone: 909-790-7070