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General NPI Number Information
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NPI Number | 1376801696
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Entity Type | Organization
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Legal Business Name | SURGICAL GROUP OF THE INLAND EMPIRE
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Dates
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Enumeration Date | 04/24/2012
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Last Update Date | 04/24/2012
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Provider Practice Location Address
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Address Line | 8680 MONROE CT STE 150
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-4881
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Country | US
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Telephone | 909-987-0899
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Fax |
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Provider Business Mailing Address
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Address Line | 8680 MONROE CT STE 150
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-4881
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Country | US
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Telephone | 909-579-3111
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Fax | 909-204-4197
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACOB HAIAVY
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Credential | MD
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Telephone | 909-579-3111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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