Provider Demographics
NPI:1023400322
Name:INTEGRATED MEDICAL CENTER OF CORONA INC.
Entity Type:Organization
Organization Name:INTEGRATED MEDICAL CENTER OF CORONA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERSIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SANDERFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MBA
Authorized Official - Phone:951-737-1252
Mailing Address - Street 1:2250 S MAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-2534
Mailing Address - Country:US
Mailing Address - Phone:951-737-1252
Mailing Address - Fax:951-737-2820
Practice Address - Street 1:2250 S MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-2534
Practice Address - Country:US
Practice Address - Phone:951-737-1252
Practice Address - Fax:951-737-2820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39736MD261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty