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General NPI Number Information
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NPI Number | 1659620987
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Entity Type | Organization
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Legal Business Name | HOSPICE SPECTRUM INLAND EMPIRE
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Dates
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Enumeration Date | 08/31/2012
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Last Update Date | 07/07/2014
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Provider Practice Location Address
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Address Line | 7365 CARNELIAN STREET SUITE 220
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-1129
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Country | US
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Telephone | 909-256-4050
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Fax | 909-440-8100
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Provider Business Mailing Address
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Address Line | 7365 CARNELIAN STREET SUITE 220
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-1129
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Country | US
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Telephone | 909-256-4050
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Fax | 909-440-8100
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOEL G OMBAO
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Credential | NURSE PRACTITIONER
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Telephone | 909-800-0883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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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 | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 550002207
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License Number State | CA
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