Healthcare Provider Details

I. General information

NPI: 1457457103
Provider Name (Legal Business Name): CORONA REGIONAL CARDIOLOGY AND EKG PANEL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S MAIN ST
CORONA CA
92882-3420
US

IV. Provider business mailing address

PO BOX 2139
CORONA CA
92878-2139
US

V. Phone/Fax

Practice location:
  • Phone: 951-737-4343
  • Fax:
Mailing address:
  • Phone: 951-280-5350
  • Fax: 951-371-2804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: WILCOTTE RAHMING
Title or Position: PRESIDENT
Credential: M.D.
Phone: 951-280-5350