Provider Demographics
NPI:1689339186
Name:INLAND BREAST AND BODY SURGERY CENTER
Entity Type:Organization
Organization Name:INLAND BREAST AND BODY SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREASEN
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:909-844-5837
Mailing Address - Street 1:1541 MARION RD
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-6332
Mailing Address - Country:US
Mailing Address - Phone:909-563-3015
Mailing Address - Fax:
Practice Address - Street 1:3333 CONCOURS ST
Practice Address - Street 2:BUILDING #1 SUITE 1100
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764
Practice Address - Country:US
Practice Address - Phone:909-563-3015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical