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General NPI Number Information
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NPI Number | 1427104116
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Entity Type | Organization
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Legal Business Name | INLAND PSYCHIATRIC MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 23110 ATLANTIC CIR STE B&D
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City | MORENO VALLEY
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State | CA
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Zip | 92553-5920
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Country | US
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Telephone | 951-243-6455
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Fax | 512-430-2079
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Provider Business Mailing Address
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Address Line | 1809 W REDLANDS BLVD
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City | REDLANDS
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State | CA
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Zip | 92373-8054
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Country | US
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Telephone | 909-307-1320
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Fax | 909-798-3607
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Authorized Official
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Title or Position | CREDENTIALING
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Name | AMBER GUTIERREZ
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Credential |
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Telephone | 909-289-4075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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