Healthcare Provider Details

I. General information

NPI: 1689194029
Provider Name (Legal Business Name): MANSOOKLAL RATANJEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 06/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31021 TEMECULA PKWY
TEMECULA CA
92592-2991
US

IV. Provider business mailing address

31830 BIAGIO WAY
WINCHESTER CA
92596-8533
US

V. Phone/Fax

Practice location:
  • Phone: 951-303-9417
  • Fax:
Mailing address:
  • Phone: 19512645940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number56099
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: