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Organization

INLAND EMPIRE SURGICAL GROUP, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MARYAM ROHAM PHARMD (ADMINISTRATOR)
(310) 621-0060
Entity
Organization

Contact information

Practice address
8680 MONROE CT, SUITE #100, RANCHO CUCAMONGA, CA 91730-4880
(909) 579-3111
(909) 579-3113
Mailing address
8680 MONROE CT, SUITE #100, RANCHO CUCAMONGA, CA 91730-4880
(909) 579-3111
(909) 579-3113

Taxonomy

Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
CA
207L00000X
Anesthesiology Physician
207LP2900X
Pain Medicine (Anesthesiology) Physician
CA
207RG0100X
Gastroenterology Physician
CA
207V00000X
Obstetrics & Gynecology Physician
CA
207X00000X
Orthopaedic Surgery Physician
CA
207Y00000X
Otolaryngology Physician
CA
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
CA
208600000X
Surgery Physician
Primary
CA
208VP0014X
Interventional Pain Medicine Physician
CA
213E00000X
Podiatrist
CA
213ER0200X
Radiology Podiatrist
CA

Other

Enumeration date
10/13/2010
Last updated
10/13/2010
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