Provider Demographics
NPI:1295270254
Name:INLAND EMPIRE WOMANS CENTER, MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:INLAND EMPIRE WOMANS CENTER, MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:LANGDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-474-9952
Mailing Address - Street 1:1800 N. WESTERN AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92411
Mailing Address - Country:US
Mailing Address - Phone:909-474-9952
Mailing Address - Fax:909-474-9951
Practice Address - Street 1:1800 WESTERN AVE STE 204
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1353
Practice Address - Country:US
Practice Address - Phone:909-474-9952
Practice Address - Fax:909-474-9951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-30
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA109432261QM2500X
207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty