| Organization Name: | INLAND EMPIRE SPINAL DECOMPRESSION CENTERS |
| NPI Number: | 1043481450 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | VICTOR HUGO FANTASIA (CFO) |
| Mailing Address: | 203 W G St Ste B Ontario |
| State: | CA US |
| Postal Code: | 917623227 |
| Phone Number: | 9099861611 |
| Fax Number: | 9094675594 |
| NPI Enumeration Date: | 03/13/2008 |
| NPI Last Update Date: | 03/13/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | 15464 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |