Provider Demographics
NPI:1801761358
Name:SAN GORGONIO MEMORIAL HEALTH CARE DISTRICT
Entity type:Organization
Organization Name:SAN GORGONIO MEMORIAL HEALTH CARE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEUTIVE
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-769-2121
Mailing Address - Street 1:264 N HIGHLAND SPRINGS AVE STE 3D
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-3085
Mailing Address - Country:US
Mailing Address - Phone:951-951-2762
Mailing Address - Fax:951-848-7985
Practice Address - Street 1:264 N HIGHLAND SPRINGS AVE STE 3D
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-3085
Practice Address - Country:US
Practice Address - Phone:951-951-2762
Practice Address - Fax:951-848-7985
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAN GORGONIO MEMORIAL HEALTH CARE DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty