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General NPI Number Information
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NPI Number | 1023336252
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Entity Type | Organization
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Legal Business Name | INLAND EMPIRE FERTILITY CENTER MEDICAL GROUP CORP.
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Dates
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Enumeration Date | 05/12/2010
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Last Update Date | 05/12/2010
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Provider Practice Location Address
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Address Line | 69265 RAMON RD SUITE B1
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City | CATHEDRAL CITY
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State | CA
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Zip | 92234-3391
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Country | US
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Telephone | 760-770-5880
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Fax | 760-770-5875
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Provider Business Mailing Address
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Address Line | 69265 RAMON RD SUITE B1
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City | CATHEDRAL CITY
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State | CA
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Zip | 92234-3391
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Country | US
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Telephone | 760-770-5880
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Fax | 760-770-5875
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. ELLIOTT EDES
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Credential | M.D.
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Telephone | 760-770-5880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G59464
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License Number State | CA
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