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General NPI Number Information
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NPI Number | 1376876912
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Entity Type | Organization
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Legal Business Name | PINNACLE MEDICAL GROUP, INC
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Dates
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Enumeration Date | 09/15/2009
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Last Update Date | 04/04/2023
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Provider Practice Location Address
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Address Line | 8110 MANGO AVE
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City | FONTANA
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State | CA
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Zip | 92335-3603
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Country | US
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Telephone | 909-427-1303
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 12209
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City | SAN BERNARDINO
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State | CA
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Zip | 92424-2209
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Country | US
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Telephone | 909-357-1595
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Fax | 909-357-1203
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. CHARLES S SABBAH
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Credential | M.D.
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Telephone | 909-357-1595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | CA
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