Provider Demographics
NPI:1417448168
Name:INLAND VALLEY TRAUMA AND ACUTE CARE SURGERY APC INC
Entity Type:Organization
Organization Name:INLAND VALLEY TRAUMA AND ACUTE CARE SURGERY APC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TITO
Authorized Official - Middle Name:FLAVIO
Authorized Official - Last Name:GORSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-331-9040
Mailing Address - Street 1:36320 INLAND VALLEY DR STE 101A
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-7512
Mailing Address - Country:US
Mailing Address - Phone:951-698-3000
Mailing Address - Fax:951-698-7700
Practice Address - Street 1:36320 INLAND VALLEY DR STE 101A
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595
Practice Address - Country:US
Practice Address - Phone:951-698-3000
Practice Address - Fax:951-698-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-29
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1508958240OtherNPI