Healthcare Provider Details

I. General information

NPI: 1801254479
Provider Name (Legal Business Name): NEONATOLOGY MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2016
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33353 YUCAIPA BLVD
YUCAIPA CA
92399-2018
US

IV. Provider business mailing address

33353 YUCAIPA BLVD
YUCAIPA CA
92399-2018
US

V. Phone/Fax

Practice location:
  • Phone: 909-790-5071
  • Fax:
Mailing address:
  • Phone: 909-790-5071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ERNEST BARRIO
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 909-790-5071