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General NPI Number Information
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NPI Number | 1891862553
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Entity Type | Organization
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Legal Business Name | BASELINE MEDICAL CLINIC, INC
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 11/28/2017
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Provider Practice Location Address
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Address Line | 330 N D ST STE 300
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City | SAN BERNARDINO
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State | CA
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Zip | 92401-1522
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Country | US
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Telephone | 909-888-6602
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Fax | 909-885-7494
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Provider Business Mailing Address
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Address Line | 330 N D ST STE 300
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City | SAN BERNARDINO
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State | CA
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Zip | 92401-1522
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Country | US
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Telephone | 909-888-6602
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Fax | 909-888-6619
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | HOANG-CHUONG N VU
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Credential | M.D.
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Telephone | 909-888-6602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | C27156
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License Number State | CA
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