Provider Demographics
NPI:1548254980
Name:INLAND HOSPITALISTS MED GP
Entity type:Organization
Organization Name:INLAND HOSPITALISTS MED GP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ARDILA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-692-5180
Mailing Address - Street 1:PO BOX 80590
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91118-8590
Mailing Address - Country:US
Mailing Address - Phone:714-692-5180
Mailing Address - Fax:714-692-5180
Practice Address - Street 1:11705 SLATE AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-5196
Practice Address - Country:US
Practice Address - Phone:951-351-7726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0101830Medicaid
CAZZZ27719ZMedicare ID - Type Unspecified