Provider Demographics
NPI:1619632692
Name:INLAND EMPIRE MD SENIOR CARE MEDICAL CORP.
Entity Type:Organization
Organization Name:INLAND EMPIRE MD SENIOR CARE MEDICAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBI-HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-531-7242
Mailing Address - Street 1:16954 CRAMER CIR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-6278
Mailing Address - Country:US
Mailing Address - Phone:951-531-7242
Mailing Address - Fax:
Practice Address - Street 1:16460 VICTOR ST
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3918
Practice Address - Country:US
Practice Address - Phone:760-245-6925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-03
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20700000XMedicaid