Provider Demographics
NPI:1023336252
Name:INLAND EMPIRE FERTILITY CENTER MEDICAL GROUP CORP.
Entity type:Organization
Organization Name:INLAND EMPIRE FERTILITY CENTER MEDICAL GROUP CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:EDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-770-5880
Mailing Address - Street 1:69265 RAMON RD
Mailing Address - Street 2:SUITE B1
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-3391
Mailing Address - Country:US
Mailing Address - Phone:760-770-5880
Mailing Address - Fax:760-770-5875
Practice Address - Street 1:69265 RAMON RD
Practice Address - Street 2:SUITE B1
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-3391
Practice Address - Country:US
Practice Address - Phone:760-770-5880
Practice Address - Fax:760-770-5875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59464174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty