Provider Demographics
NPI:1205127941
Name:INLAND EMPIRE DIAGNOSTICS INC
Entity type:Organization
Organization Name:INLAND EMPIRE DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KRISTOFER
Authorized Official - Middle Name:
Authorized Official - Last Name:KISNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-454-2673
Mailing Address - Street 1:41865 BOARDWALK STE 119
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-9032
Mailing Address - Country:US
Mailing Address - Phone:760-507-1156
Mailing Address - Fax:800-490-0801
Practice Address - Street 1:41865 BOARDWALK STE 119
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-9032
Practice Address - Country:US
Practice Address - Phone:760-507-1156
Practice Address - Fax:800-490-0801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-28
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherWORKCOMP
CA6949950001Medicare NSC