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General NPI Number Information
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NPI Number | 1215195276
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Entity Type | Organization
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Legal Business Name | INLAND EMPIRE WOUND CARE & INFUSION CENTER
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Dates
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Enumeration Date | 05/27/2008
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Last Update Date | 05/27/2008
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Provider Practice Location Address
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Address Line | 14114 BUSINESS CENTER DR SUITE D
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City | MORENO VALLEY
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State | CA
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Zip | 92553-9113
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Country | US
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Telephone | 951-697-1150
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Fax | 951-697-1189
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Provider Business Mailing Address
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Address Line | 14114 BUSINESS CENTER DR SUITE D
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City | MORENO VALLEY
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State | CA
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Zip | 92553-9113
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Country | US
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Telephone | 951-697-1150
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Fax | 951-697-1189
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JOHN A. LIQUETE
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Credential | M.D.
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Telephone | 951-697-1150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number | A49014
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License Number State | CA
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