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General NPI Number Information
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NPI Number | 1295270254
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Entity Type | Organization
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Legal Business Name | INLAND EMPIRE WOMANS CENTER, MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 12/30/2016
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Last Update Date | 03/26/2024
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Provider Practice Location Address
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Address Line | 1800 WESTERN AVE STE 204
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City | SAN BERNARDINO
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State | CA
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Zip | 92411-1353
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Country | US
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Telephone | 909-474-9952
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Fax | 909-474-9951
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Provider Business Mailing Address
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Address Line | 1800 N. WESTERN AVE SUITE 204
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City | SAN BERNARDINO
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State | CA
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Zip | 92411
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Country | US
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Telephone | 909-474-9952
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Fax | 909-474-9951
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Authorized Official
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Title or Position | CEO
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Name | JEFFREY RYAN LANGDON
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Credential |
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Telephone | 909-474-9952
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | A109432
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License Number State | CA
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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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