Provider Demographics
NPI:1639381783
Name:SURGICAL ARTS OF THE INLAND EMPIRE INC.
Entity Type:Organization
Organization Name:SURGICAL ARTS OF THE INLAND EMPIRE INC.
Other - Org Name:SURGICAL ARTS OF THE INLAND EMPIRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIAVY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-579-3111
Mailing Address - Street 1:8680 MONROE CT.
Mailing Address - Street 2:#100
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730
Mailing Address - Country:US
Mailing Address - Phone:909-579-3111
Mailing Address - Fax:
Practice Address - Street 1:8680 MONROE CT
Practice Address - Street 2:#100
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4880
Practice Address - Country:US
Practice Address - Phone:909-579-3111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty