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General NPI Number Information
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NPI Number | 1194243642
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Entity Type | Organization
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Legal Business Name | SAN GORGONIO MEMORIAL HEALTH CARE DISTRICT
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Dates
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Enumeration Date | 09/05/2017
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Last Update Date | 01/26/2026
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Provider Practice Location Address
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Address Line | 264 N HIGHLAND SPRINGS AVE STE 3D
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City | BANNING
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State | CA
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Zip | 92220-3085
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Country | US
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Telephone | 951-846-2877
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Fax | 951-846-2876
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Provider Business Mailing Address
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Address Line | 264 N HIGHLAND SPRINGS AVE STE 3D
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City | BANNING
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State | CA
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Zip | 92220-3085
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Country | US
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Telephone | 951-769-4897
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Fax | 951-848-7985
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Authorized Official
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Title or Position | CHIEF NURSING EXECUTIVE/VP
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Name | MRS. ANGELA BRADY
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Credential | DNP, CENP, APRN, C
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Telephone | 517-692-1859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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