Basic Information
| Provider Information | |||||||||
| NPI: | 1285381756 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INLAND EMPIRE MULTISPECIALTY GROUP PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MAGNOLIA OB/GYN CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 495 E RINCON ST STE 208 | ||||||||
| Address2: | |||||||||
| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928791379 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6926 BROCKTON AVE STE 7 | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925063804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513542229 | ||||||||
| FaxNumber: | 8336309896 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2022 | ||||||||
| LastUpdateDate: | 10/24/2022 | ||||||||
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| AuthorizedOfficialLastName: | VILLANUEVA | ||||||||
| AuthorizedOfficialFirstName: | YARA | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR MANAGER / ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9513543221 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | INLAND EMPIRE MULTISPECIALTY GROUP PC | ||||||||
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| NPICertificationDate: | 10/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.