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General NPI Number Information
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NPI Number | 1447343223
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Entity Type | Organization
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Legal Business Name | CORNERSTONE MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 04/13/2010
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Provider Practice Location Address
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Address Line | 1881 COMMERCENTER E SUITE 112
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City | SAN BERNARDINO
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State | CA
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Zip | 92408
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Country | US
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Telephone | 909-890-1888
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Fax | 909-890-0196
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Provider Business Mailing Address
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Address Line | P.O. BOX 351
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City | SAN BERNARDINO
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State | CA
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Zip | 92402-0351
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Country | US
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Telephone | 909-890-1888
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Fax | 909-890-0196
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | DR. MICHELE H VANDYKE
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Credential | D.C.
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Telephone | 909-890-1888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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