Provider Demographics
NPI:1487613766
Name:INLAND CENTER MEDICAL GROUP, P.C.
Entity type:Organization
Organization Name:INLAND CENTER MEDICAL GROUP, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DHARMESH
Authorized Official - Middle Name:S
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-989-7551
Mailing Address - Street 1:8330 RED OAK STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-0603
Mailing Address - Country:US
Mailing Address - Phone:909-989-7551
Mailing Address - Fax:909-945-5427
Practice Address - Street 1:8330 RED OAK STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0603
Practice Address - Country:US
Practice Address - Phone:909-989-7551
Practice Address - Fax:909-945-5427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty