=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891983730
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INLAND VALLEY MED SVCS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2007
-----------------------------------------------------
Last Update Date | 12/21/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 491 S LASALLE STREET
-----------------------------------------------------
City | REDLANDS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92374-6472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-792-2086
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 491 LASALLE STREET
-----------------------------------------------------
City | REDLANDS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92374-6472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. LOLITA TUVERA REYES
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 909-709-2045
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | EM018A
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------