Organization Name: | INLAND PSYCHIATRIC MEDICAL GROUP, INC. |
NPI Number: | 1881943066 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SYAM P KUNAM (CEO) |
Mailing Address: | 29099 Hospital Road Suite 107 Lake Arrowhead |
State: | CA US |
Postal Code: | 923520070 |
Phone Number: | 9093353026 |
Fax Number: | 9093353167 |
NPI Enumeration Date: | 09/05/2012 |
NPI Last Update Date: | 09/05/2012 |
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: |