Healthcare Provider Details

I. General information

NPI: 1063663656
Provider Name (Legal Business Name): FAMILY HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12730 HEACOCK ST #4
MORENO VALLEY CA
92553-3040
US

IV. Provider business mailing address

PO BOX 788
HEMET CA
92546-0788
US

V. Phone/Fax

Practice location:
  • Phone: 951-288-6688
  • Fax:
Mailing address:
  • Phone: 951-929-6260
  • Fax: 951-765-2855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA93185
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA93185
License Number StateCA

VIII. Authorized Official

Name: ESTEBAN PONI
Title or Position: OWNER
Credential: M.D.
Phone: 951-288-6688