Provider Demographics
NPI:1023180189
Name:MISSION MEDICAL GROUP OF THE INLAND EMPIRE
Entity Type:Organization
Organization Name:MISSION MEDICAL GROUP OF THE INLAND EMPIRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOC VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-467-7640
Mailing Address - Street 1:9275 SKY PARK CT STE 400
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4386
Mailing Address - Country:US
Mailing Address - Phone:858-467-7640
Mailing Address - Fax:858-467-7649
Practice Address - Street 1:9275 SKY PARK CT STE 400
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4386
Practice Address - Country:US
Practice Address - Phone:858-467-7640
Practice Address - Fax:858-467-7649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization