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General NPI Number Information
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NPI Number | 1215310909
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Entity Type | Organization
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Legal Business Name | IB SURGERY INC
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Dates
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Enumeration Date | 06/30/2015
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 12740 HESPERIA RD STE B
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City | VICTORVILLE
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State | CA
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Zip | 92395
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Country | US
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Telephone | 760-410-6100
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Fax | 760-854-4100
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Provider Business Mailing Address
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Address Line | PO BOX 1792
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City | UPLAND
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State | CA
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Zip | 91785-1792
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Country | US
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Telephone | 760-410-6100
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Fax | 761-854-4100
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Authorized Official
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Title or Position | CEO
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Name | IRENE BIELAWIEC HOUARI
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Credential | MD
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Telephone | 973-738-7336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A117875
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License Number State | CA
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