Provider Demographics
NPI:1215310909
Name:IB SURGERY INC
Entity type:Organization
Organization Name:IB SURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:BIELAWIEC
Authorized Official - Last Name:HOUARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-738-7336
Mailing Address - Street 1:PO BOX 1792
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91785-1792
Mailing Address - Country:US
Mailing Address - Phone:760-410-6100
Mailing Address - Fax:761-854-4100
Practice Address - Street 1:12740 HESPERIA RD STE B
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395
Practice Address - Country:US
Practice Address - Phone:760-410-6100
Practice Address - Fax:760-854-4100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-30
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA117875208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty