Provider Demographics
NPI:1285381756
Name:INLAND EMPIRE MULTISPECIALTY GROUP PC
Entity type:Organization
Organization Name:INLAND EMPIRE MULTISPECIALTY GROUP PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR MANAGER / ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YARA
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLANUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-354-3221
Mailing Address - Street 1:495 E RINCON ST STE 208
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-1379
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6926 BROCKTON AVE STE 7
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3804
Practice Address - Country:US
Practice Address - Phone:951-354-2229
Practice Address - Fax:833-630-9896
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INLAND EMPIRE MULTISPECIALTY GROUP PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-04
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty