Organization
INLAND EMPIRE MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS OLIVEIRA DO (MEDICAL DIRECTOR)
(909) 581-5447
Entity
Organization
Contact information
Practice address
506 W GRAHAM AVE STE 107, LAKE ELSINORE, CA 92530-3665
(909) 581-5447
Mailing address
219 CALLE MORENO, SAN DIMAS, CA 91773-3970
(909) 581-5447
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
04/28/2020
Last updated
04/28/2020
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