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Organization
INLAND EMPIRE MEDICAL NERTWORK, INC.
Active
Organization
INLAND EMPIRE MEDICAL NERTWORK, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURIE MANOS (CREDENTIALING)
(909) 398-1550
Entity
Organization
Contact information
Practice address
9190 HAVEN AVE, 1ST FLOOR, RANCHO CUCAMONGA, CA 91730-5431
(909) 581-6732
(909) 581-6737
Mailing address
9140 HAVEN AVE, SUITE 110, RANCHO CUCAMONGA, CA 91730-5414
(909) 398-1550
(909) 398-1573
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
04/06/2011
Last updated
04/06/2011
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