MEDICARE: INLAND EMPIRE DIAGNOSTICS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246Z00000X	Other Specialist/Technologist
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1205127941
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INLAND EMPIRE DIAGNOSTICS INC

Provider Business Mailing Address
First Line	:	41865 BOARDWALK STE 119
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-9032
Country	:	US
Telephone Number	:	760-507-1156
Fax Number	:	800-490-0801

Provider Business Practice Location Address
First Line	:	41865 BOARDWALK STE 119
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-9032
Country	:	US
Telephone Number	:	760-507-1156
Fax Number	:	800-490-0801

Authorized Official
Title or Position	:	OWNER
Name	:	MR. KRISTOFER KISNER
Credential	:
Telephone Number	:	951-454-2673

Provider Enumeration Date	:	04/28/2011
Last Update Date	:	12/08/2020

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