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General NPI Number Information
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NPI Number | 1417578790
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Entity Type | Organization
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Legal Business Name | INLAND EMPIRE MEDICAL GROUP, INC
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Dates
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Enumeration Date | 04/28/2020
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Last Update Date | 04/28/2020
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Provider Practice Location Address
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Address Line | 506 W GRAHAM AVE STE 107
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City | LAKE ELSINORE
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State | CA
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Zip | 92530-3665
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Country | US
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Telephone | 909-581-5447
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Fax |
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Provider Business Mailing Address
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Address Line | 219 CALLE MORENO
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City | SAN DIMAS
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State | CA
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Zip | 91773-3970
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Country | US
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Telephone | 909-581-5447
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | THOMAS OLIVEIRA
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Credential | DO
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Telephone | 909-581-5447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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