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General NPI Number Information
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NPI Number | 1336216407
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Entity Type | Organization
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Legal Business Name | RANCHO PEDIATRIC ASSOCIATES
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7777 MILLIKEN AVE STE 130
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-6781
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Country | US
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Telephone | 909-941-7008
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Fax | 909-481-6855
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Provider Business Mailing Address
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Address Line | 7777 MILLIKEN AVE STE 130
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-6781
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Country | US
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Telephone | 909-941-7008
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Fax | 909-481-6855
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Authorized Official
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Title or Position | PYSICIAN
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Name | DR. PETER DAVID AMBROSE
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Credential | M.D.
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Telephone | 909-941-7008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G-21832
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License Number State | CA
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