INLAND EMPIRE MEDICAL GROUP, INC (NPI# 1417578790) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417578790 |
| Entity Type | Organization |
| Organization Name | INLAND EMPIRE MEDICAL GROUP, INC |
| Practice Address |
506 W Graham Ave Ste 107 Lake Elsinore CA 92530-3665 |
| Mailing Address |
219 Calle Moreno San Dimas CA 91773-3970 |
| Practice Telephone | 9095815447 |
| Mailing Telephone | 9095815447 |
| Enumeration Date | 2020-04-28 |
| Last Update Date | 2020-04-28 |
| Authorized Official Name | THOMAS OLIVEIRA (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 9095815447 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208D00000X | General Practice | Allopathic & Osteopathic Physicians | ||
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548823867 | Inland Empire Medical Group, Inc | Family Medicine | 10250 Country Club Dr Ste A, Jurupa Valley, CA 91752-1328 | 2019-04-22 |
| Street Address |
506 W GRAHAM AVE STE 107 |
| City | LAKE ELSINORE |
| State | CA |
| Zip Code | 92530-3665 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841801479 | Mercedes Samantha Hamilton | Licensed Psychiatric Technician | 18465 Grand Ave, Lake Elsinore, CA 92530 | 2020-08-17 |
| 1700423779 | Karrene Louise Stanard | Peer Specialist | 31764 Casino Drive, Suite 300, Lake Elsinore, CA 92530 | 2019-12-09 |
| 1972149961 | Danielle Cravalho | Student in an Organized Health Care Education/Training Program | 31964 Mission Trail, Suite B, Lake Elsinore, CA 92530 | 2019-11-25 |
| 1952825648 | R.e. Levi Dental Corporation | Dentist | 32235 Mission Trail # 8, Lake Elsinore, CA 92530 | 2017-08-03 |
| 1144760729 | Alfred Metwashla | Pharmacist | 18269 Collier Ave, Lake Elsinore, CA 92530 | 2017-03-02 |
| 1750788733 | Roxanne Martinez | Case Manager/Care Coordinator | 31764 Casino Drive, Lake Elsinore, CA 92530 | 2014-11-19 |
| 1871870907 | Bryan Tuan Tran | Pharmacist | 160 Diamond Drive, Lake Elsinore, CA 92530 | 2011-11-03 |
| 1043590821 | Katherynn Elizabeth Williams | Marriage & Family Therapist | 600 Central Ave Ste 201, Lake Elsinore, CA 92530 | 2011-08-24 |
| 1861771677 | Judy Kelly | Marriage & Family Therapist | 224 West Graham Ave, Lake Elsinore, CA 92530 | 2011-08-10 |
| 1427343813 | Patrick Chern | Pharmacist | 18287 Collier Ave., Lake Elsinore, CA 92530 | 2011-06-14 |
| Find all providers in zip 92530 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821258922 | Sandar Kyi | Clinic/Center | 2499 E Lakeshore Dr, Lake Elsinore, CA 92530-4446 | 2008-06-11 |
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| 1538772843 | Unlimited Urgent Care Inc. | Clinic/Center | 8781 Van Nuys Blvd Ste A, Panorama City, CA 91402-2401 | 2020-08-26 |
| Find all providers with the same taxonomy | ||||
| City | LAKE ELSINORE |
| Zip Code | 92530 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.