# INLAND EMPIRE EXTRA CARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942590351
- **Authorized official:** DR. ZAHER AZZAWI M.D (PRESIDENT)
- **Authorized official phone:** (909) 483-8361

## Contact information

- **Practice address:** 10841 WHITE OAK AVE, SUITE 107, RANCHO CUCAMONGA, CA 91730-3811
- **Practice address phone:** (909) 483-8361
- **Practice address fax:** (909) 483-2070
- **Mailing address:** 10841 WHITE OAK AVE, SUITE 107, RANCHO CUCAMONGA, CA 91730-3811
- **Mailing address phone:** (909) 483-8361
- **Mailing address fax:** (909) 483-2070

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | A48743 | CA | Yes |
| 305R00000X | Preferred Provider Organization | A48743 | CA | — |

## Other

- **Enumeration date:** 04/19/2011
- **Last updated:** 04/19/2011