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General NPI Number Information
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NPI Number | 1689339186
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Entity Type | Organization
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Legal Business Name | INLAND BREAST AND BODY SURGERY CENTER
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Dates
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Enumeration Date | 11/01/2021
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Last Update Date | 11/01/2021
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Provider Practice Location Address
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Address Line | 3333 CONCOURS ST BUILDING #1 SUITE 1100
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City | ONTARIO
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State | CA
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Zip | 91764
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Country | US
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Telephone | 909-563-3015
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Fax |
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Provider Business Mailing Address
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Address Line | 1541 MARION RD
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City | REDLANDS
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State | CA
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Zip | 92374-6332
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Country | US
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Telephone | 909-563-3015
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF NURSING
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Name | ZACHARY ANDREASEN
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Credential | BSN
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Telephone | 909-844-5837
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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