Provider Demographics
NPI:1679119580
Name:VANGUARD HEALTH
Entity type:Organization
Organization Name:VANGUARD HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:IOELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-356-4132
Mailing Address - Street 1:10557 JUNIPER AVE STE E2
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-7589
Mailing Address - Country:US
Mailing Address - Phone:909-356-4132
Mailing Address - Fax:562-941-4767
Practice Address - Street 1:10557 JUNIPER AVE STE E2
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92337-7589
Practice Address - Country:US
Practice Address - Phone:909-356-4132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)