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General NPI Number Information
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NPI Number | 1720359573
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Entity Type | Organization
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Legal Business Name | IC GROUP INC
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Dates
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Enumeration Date | 01/24/2012
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Last Update Date | 01/24/2012
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Provider Practice Location Address
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Address Line | 3130 NEW HAMPSHIRE DR
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City | CORONA
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State | CA
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Zip | 92881-8312
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Country | US
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Telephone | 951-403-4501
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Fax | 951-905-5417
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Provider Business Mailing Address
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Address Line | 3130 NEW HAMPSHIRE DR
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City | CORONA
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State | CA
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Zip | 92881-8312
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Country | US
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Telephone | 951-403-4501
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Fax | 951-905-5417
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MR. SARFARAZ HASAN KHAN
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Credential |
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Telephone | 951-403-4501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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