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General NPI Number Information
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NPI Number | 1487427142
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Entity Type | Organization
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Legal Business Name | INLAND EMPIRE PEDIATRIC CARDIOLOGY
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Dates
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Enumeration Date | 11/03/2023
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 15632 BEAR VALLEY RD STE 106
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City | VICTORVILLE
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State | CA
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Zip | 92395-8518
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Country | US
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Telephone | 760-221-1318
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Fax |
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Provider Business Mailing Address
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Address Line | 15632 BEAR VALLEY RD STE 106
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City | VICTORVILLE
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State | CA
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Zip | 92395-8518
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Country | US
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Telephone | 760-221-1318
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HANI GHAWI
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Credential | MD, MSC, FAAP, FASE
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Telephone | 760-221-1318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number |
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License Number State |
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