Provider Demographics
NPI:1184978637
Name:INLAND VALLEY SURGERY CENTER, LLC
Entity type:Organization
Organization Name:INLAND VALLEY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACHARSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-679-0400
Mailing Address - Street 1:41900 WINCHESTER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-3403
Mailing Address - Country:US
Mailing Address - Phone:951-461-6502
Mailing Address - Fax:
Practice Address - Street 1:41900 WINCHESTER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-3403
Practice Address - Country:US
Practice Address - Phone:951-461-6502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical