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General NPI Number Information
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NPI Number | 1639381783
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Entity Type | Organization
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Legal Business Name | SURGICAL ARTS OF THE INLAND EMPIRE INC.
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 07/27/2012
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Provider Practice Location Address
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Address Line | 8680 MONROE CT #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 |
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Provider Business Mailing Address
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Address Line | 8680 MONROE CT. #100
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730
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Country | US
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Telephone | 909-579-3111
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JACOB HAIAVY
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Credential | M.D.
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Telephone | 909-579-3111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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