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General NPI Number Information
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NPI Number | 1891364576
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Entity Type | Organization
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Legal Business Name | INLAND EMPIRE MULTISPECIALTY GROUP PC
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Dates
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Enumeration Date | 06/17/2021
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Last Update Date | 05/02/2022
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Provider Practice Location Address
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Address Line | 6926 BROCKTON AVE STE 4
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City | RIVERSIDE
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State | CA
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Zip | 92506-3804
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Country | US
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Telephone | 844-400-2236
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Fax | 951-382-4111
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Provider Business Mailing Address
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Address Line | 495 E RINCON ST STE 208
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City | CORONA
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State | CA
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Zip | 92879-1379
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | DANIELA ZENDEJAS
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Credential |
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Telephone | 951-354-3177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology 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 | 2088F0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician
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License Number |
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License Number State |
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