Provider Demographics
NPI:1790029205
Name:PINNACLE MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:PINNACLE MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:SABBAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-881-4115
Mailing Address - Street 1:P.O. BOX 12209
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92423-2209
Mailing Address - Country:US
Mailing Address - Phone:909-335-4118
Mailing Address - Fax:909-793-2916
Practice Address - Street 1:300 S HIGHLAND SPRINGS AVE
Practice Address - Street 2:SUITE 2D
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-6504
Practice Address - Country:US
Practice Address - Phone:951-769-5378
Practice Address - Fax:951-769-5645
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINNACLE MEDICAL GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-21
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207P00000X, 207Q00000X
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty