Organization Name: | INLAND PSYCHIATRIC MEDICAL GROUP, INC |
NPI Number: | 1003132796 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | NALLAMOTHU BHUVANESWARI (PHYSICIAN) |
Mailing Address: | 264 N Highland Springs Ave Suite C Banning |
State: | CA US |
Postal Code: | 922203082 |
Phone Number: | 9512436455 |
Fax Number: | 9512430207 |
NPI Enumeration Date: | 04/20/2010 |
NPI Last Update Date: | 04/20/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |