Provider Demographics
NPI:1295170249
Name:INLAND EMPIRE MEDICAL NETWORK
Entity type:Organization
Organization Name:INLAND EMPIRE MEDICAL NETWORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VISWANATHA
Authorized Official - Middle Name:J
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-483-3311
Mailing Address - Street 1:9140 HAVEN AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5414
Mailing Address - Country:US
Mailing Address - Phone:909-483-3311
Mailing Address - Fax:909-483-2911
Practice Address - Street 1:9140 HAVEN AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5414
Practice Address - Country:US
Practice Address - Phone:909-483-3311
Practice Address - Fax:909-483-2911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization