Organization Name: | IAM MEDICAL CLINIC |
NPI Number: | 1659613693 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CHIOMA KALU (DIRECTOR) |
Mailing Address: | 5250 University Pkwy A San Bernardino |
State: | CA US |
Postal Code: | 924077051 |
Phone Number: | 9096849334 |
Fax Number: | 9094631426 |
NPI Enumeration Date: | 03/16/2013 |
NPI Last Update Date: | 03/16/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | A102218 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |