Healthcare Provider Details

I. General information

NPI: 1689826026
Provider Name (Legal Business Name): IGOR M BRON MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 01/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27300 IRIS AVE
MORENO VALLEY CA
92555-4802
US

IV. Provider business mailing address

PO BOX 788
HEMET CA
92546-0788
US

V. Phone/Fax

Practice location:
  • Phone: 951-243-0811
  • Fax: 661-323-4703
Mailing address:
  • Phone: 951-929-6260
  • Fax: 951-765-2855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA64227
License Number StateCA

VIII. Authorized Official

Name: IGOR M BRON
Title or Position: OWNER
Credential: MD
Phone: 714-636-0342