Provider Demographics
NPI:1861502841
Name:INLAND EMPIRE ANESTHESIA MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:INLAND EMPIRE ANESTHESIA MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:COMUNALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-580-2440
Mailing Address - Street 1:310 N INDIAN HILL BLVD # 601
Mailing Address - Street 2:INLAND EMPIRE ANESTHESIA MEDICAL GROUP
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4611
Mailing Address - Country:US
Mailing Address - Phone:909-580-2440
Mailing Address - Fax:909-580-2441
Practice Address - Street 1:400 N PEPPER AVE
Practice Address - Street 2:DEPARTMENT OF ANESTHESIA
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1801
Practice Address - Country:US
Practice Address - Phone:909-580-2440
Practice Address - Fax:909-580-2441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGR0012030207L00000X, 207LC0200X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty