Provider Demographics
NPI:1851587448
Name:IRONSTONE MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:IRONSTONE MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.F.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ATAEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-355-4226
Mailing Address - Street 1:4121 BROCKTON AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-3442
Mailing Address - Country:US
Mailing Address - Phone:949-355-4224
Mailing Address - Fax:951-778-0051
Practice Address - Street 1:4121 BROCKTON AVE STE 104
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3442
Practice Address - Country:US
Practice Address - Phone:949-355-4224
Practice Address - Fax:951-778-0051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106704208D00000X, 261QM1300X, 261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Multi-Specialty