Healthcare Provider Details

I. General information

NPI: 1336741537
Provider Name (Legal Business Name): SAN CORONA CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7171 JURUPA AVE STE 3
RIVERSIDE CA
92504-1032
US

IV. Provider business mailing address

7171 JURUPA AVE STE 3
RIVERSIDE CA
92504-1032
US

V. Phone/Fax

Practice location:
  • Phone: 951-406-1446
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: JEFF ASHCRAFT
Title or Position: OWNER
Credential:
Phone: 951-536-6246