Provider Demographics
NPI:1558837153
Name:INLAND EMPIRE HEALTH CENTERS
Entity Type:Organization
Organization Name:INLAND EMPIRE HEALTH CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:LANGDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-936-9118
Mailing Address - Street 1:1374 N WATERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-5313
Mailing Address - Country:US
Mailing Address - Phone:909-252-7101
Mailing Address - Fax:909-677-2090
Practice Address - Street 1:1374 N WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-5313
Practice Address - Country:US
Practice Address - Phone:909-252-7101
Practice Address - Fax:909-677-2090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty