Basic Information
| Provider Information | |||||||||
| NPI: | 1609019215 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INPATIENT SERVICES OF CALIFORNIA, A MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13737 NOEL RD | ||||||||
| Address2: | SUITE 1600 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752401331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4694012386 | ||||||||
| FaxNumber: | 2147122444 | ||||||||
| Practice Location | |||||||||
| Address1: | 25500 MEDICAL CENTER DR | ||||||||
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| City: | MURRIETA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925625965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516966000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2009 | ||||||||
| LastUpdateDate: | 10/28/2019 | ||||||||
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| AuthorizedOfficialLastName: | KONDAS | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP PROVIDER ENROLLMENT | ||||||||
| AuthorizedOfficialTelephone: | 9732511132 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1609019215 | 05 | CA | MEDICAID |