| Organization Name: | INLAND EMPIRE DIAGNOSTICS INC |
| NPI Number: | 1205127941 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KRISTOFER KISNER (OWNER) |
| Mailing Address: | 119 W Sulphur St Suite B-2 Lake Elsinore |
| State: | CA US |
| Postal Code: | 925303703 |
| Phone Number: | 9512455680 |
| Fax Number: | 9513441749 |
| NPI Enumeration Date: | 04/28/2011 |
| NPI Last Update Date: | 05/18/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 246Z00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Specialist/Technologist, Other |
| Taxonomy Specialization: | |
| Taxonomy Definition: | General classification identifying individuals trained on specific equipment and technical procedures in one of a collection of miscellaneous healthcare disciplines. |