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General NPI Number Information
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NPI Number | 1205905668
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Entity Type | Organization
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Legal Business Name | INLAND NEPHROLOGY MEDICAL ASSOCIATES INC
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 08/19/2021
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Provider Practice Location Address
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Address Line | 251 CAJON ST SUITE B
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City | REDLANDS
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State | CA
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Zip | 92373-5260
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Country | US
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Telephone | 909-793-7500
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Fax | 909-792-7890
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Provider Business Mailing Address
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Address Line | 251 CAJON ST SUITE B
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City | REDLANDS
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State | CA
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Zip | 92373-5260
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Country | US
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Telephone | 909-793-7500
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Fax | 909-792-7890
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MICHAEL JOSEPH BLAKELY
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Credential |
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Telephone | 909-793-7500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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