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General NPI Number Information
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NPI Number | 1366591984
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Entity Type | Organization
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Legal Business Name | INLAND SURGICAL GROUP,INC
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1881 COMMERCENTER E SUITE 118
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3456
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Country | US
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Telephone | 909-890-1880
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Fax |
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Provider Business Mailing Address
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Address Line | 1881 COMMERCENTER E SUITE 118
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3456
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Country | US
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Telephone | 909-890-1880
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IFEANYI K UGOCHUKU
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Credential |
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Telephone | 909-890-1880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G86654
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License Number State | CA
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