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General NPI Number Information
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NPI Number | 1578873444
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Entity Type | Organization
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Legal Business Name | INLAND EMPIRE SURGICAL GROUP, LLC
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Dates
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Enumeration Date | 10/13/2010
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Last Update Date | 10/13/2010
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Provider Practice Location Address
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Address Line | 8680 MONROE CT SUITE #100
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-4880
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Country | US
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Telephone | 909-579-3111
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Fax | 909-579-3113
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Provider Business Mailing Address
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Address Line | 8680 MONROE CT SUITE #100
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-4880
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Country | US
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Telephone | 909-579-3111
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Fax | 909-579-3113
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARYAM ROHAM
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Credential | PHARMD
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Telephone | 310-621-0060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State | CA
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Taxonomy #6
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State | CA
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Taxonomy #7
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State | CA
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Taxonomy #8
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Taxonomy Code | 2082S0099X
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Taxonomy Name | Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
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License Number |
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License Number State | CA
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Taxonomy #9
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State | CA
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Taxonomy #10
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State | CA
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Taxonomy #11
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Taxonomy Code | 213ER0200X
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Taxonomy Name | Radiology Podiatrist
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License Number |
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License Number State | CA
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Taxonomy #12
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State | CA
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