Inland Empire Surgical Group, LLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

INLAND EMPIRE SURGICAL GROUP, LLC

Practice address

8680 Monroe CT
Suite #100
Rancho Cucamonga, CA 91730-4880

Phone

(909) 579-3111

Fax

(909) 579-3113

NPI assigned

Oct 13, 2010

Organization subpart

No

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

Authorized official

Name

Maryam Roham, PHARMD

Title

Administrator

Phone

(310) 621-0060

Specialties & licenses 12

Addresses

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

{
    "created_epoch": "1286928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286928000000",
    "number": "1578873444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8680 MONROE CT",
            "address_2": "SUITE #100",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917304880",
            "telephone_number": "909-579-3111",
            "fax_number": "909-579-3113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8680 MONROE CT",
            "address_2": "SUITE #100",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917304880",
            "telephone_number": "909-579-3111",
            "fax_number": "909-579-3113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INLAND EMPIRE SURGICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-13",
        "last_updated": "2010-10-13",
        "status": "A",
        "authorized_official_last_name": "ROHAM",
        "authorized_official_first_name": "MARYAM",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "310-621-0060",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "2082S0099X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery, Plastic Surgery Within the Head and Neck",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "CA",
            "license": null,
            "primary": true
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "213ER0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Radiology",
            "state": "CA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Inland Empire Medical Network (Chaffey Medical Group)
• Inland Empire Oral and Maxillofacial Surgeons
• Inland Empire Senior Services (Senior Helpers)
• Inland Empire Senior Services Inc (Senior Helpers)
• Inland Empire Sleep Medicine
• Inland Home Health Providers, Inc.
• Inland Interventional Medical Associates, Inc.
• Inland Physicians Service Inc (Inland Region Medical Group)
• Inland Psychiatric Medical Group, Inc
• Inland Respiratory Diagnostics

• Surgery Physician in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2010; 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.