Healthcare Provider Details

I. General information

NPI: 1578208047
Provider Name (Legal Business Name): PREFERRED MEDICAL OFFICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 BROOKSIDE AVE STE 9
REDLANDS CA
92373-5181
US

IV. Provider business mailing address

710 BROOKSIDE AVE STE 9
REDLANDS CA
92373-5181
US

V. Phone/Fax

Practice location:
  • Phone: 909-888-5281
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ESTEBAN SANTE PONI
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 909-644-4380