Provider Demographics
NPI:1134176225
Name:INLAND REHABILITATION MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:INLAND REHABILITATION MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTUS
Authorized Official - Middle Name:H
Authorized Official - Last Name:KOUNANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-580-6250
Mailing Address - Street 1:646 PALO ALTO DR
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-7321
Mailing Address - Country:US
Mailing Address - Phone:909-793-4585
Mailing Address - Fax:909-307-8031
Practice Address - Street 1:400 N PEPPER AVE
Practice Address - Street 2:RM#6A218A
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1801
Practice Address - Country:US
Practice Address - Phone:909-580-6250
Practice Address - Fax:909-580-1361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A406270Medicaid
CA00A406270Medicaid
CA00A406270Medicare ID - Type Unspecified