Provider Demographics
NPI:1194750745
Name:PINNACLE MEDICAL GROUP, INC
Entity type:Organization
Organization Name:PINNACLE MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:SABBAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-881-4115
Mailing Address - Street 1:PO BOX 12209
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92423-2209
Mailing Address - Country:US
Mailing Address - Phone:909-881-5825
Mailing Address - Fax:909-881-2695
Practice Address - Street 1:10431 LEMON AVE
Practice Address - Street 2:SUITE N
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91737-3700
Practice Address - Country:US
Practice Address - Phone:909-466-6579
Practice Address - Fax:909-466-1389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2013-01-25
Deactivation Date:2009-09-10
Deactivation Code:
Reactivation Date:2012-11-15
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty