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General NPI Number Information
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NPI Number | 1548254980
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Entity Type | Organization
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Legal Business Name | INLAND HOSPITALISTS MED GP
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Dates
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Enumeration Date | 08/31/2005
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Last Update Date | 04/03/2008
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Provider Practice Location Address
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Address Line | 11705 SLATE AVE
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City | RIVERSIDE
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State | CA
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Zip | 92505-5196
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Country | US
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Telephone | 951-351-7726
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 80590
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City | SAN MARINO
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State | CA
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Zip | 91118-8590
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Country | US
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Telephone | 714-692-5180
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Fax | 714-692-5180
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Authorized Official
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Title or Position | OWNER
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Name | EDGAR ARDILA
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Credential | MD
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Telephone | 714-692-5180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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