Organization
INLAND EMPIRE SPINAL DECOMPRESSION CENTERS
Active
Other names
Inland Valley Spinal Decompression Centers
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VICTOR HUGO FANTASIA D.C. (CFO)
(909) 986-1611
Entity
Organization
Contact information
Practice address
203 W G ST, STE B, ONTARIO, CA 91762-3227
(909) 986-1611
(909) 467-5594
Mailing address
203 W G ST STE B, ONTARIO, CA 91762-3227
(909) 986-1611
(909) 467-5594
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
15464
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1366626707
INDIVIDUAL NPI NUMBER
CA
Enumeration date
03/13/2008
Last updated
03/13/2008
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