Inland Empire Spinal Decompression Centers

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

License

15464 Issued in CA

Legal business name

INLAND EMPIRE SPINAL DECOMPRESSION CENTERS

Practice address

203 W G St
Ste B
Ontario, CA 91762-3227

Phone

(909) 986-1611

Fax

(909) 467-5594

NPI assigned

Mar 13, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Victor Hugo Fantasia, D.C.

Title

Cfo

Phone

(909) 986-1611

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Inland Valley Spinal Decompression Centers Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205366400000",
    "number": "1043481450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 W G ST STE B",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917623227",
            "telephone_number": "909-986-1611",
            "fax_number": "909-467-5594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 W G ST",
            "address_2": "STE B",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917623227",
            "telephone_number": "909-986-1611",
            "fax_number": "909-467-5594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INLAND EMPIRE SPINAL DECOMPRESSION CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-13",
        "last_updated": "2008-03-13",
        "status": "A",
        "authorized_official_last_name": "FANTASIA",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_middle_name": "HUGO",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "909-986-1611",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "CA",
            "license": "15464",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI NUMBER",
            "identifier": "1366626707",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Inland Valley Spinal Decompression Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Health Service Clinic/Center in Ontario, CA
• Providers in Ontario, CA by specialty
• Health Service Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.