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General NPI Number Information
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NPI Number | 1346392875
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Entity Type | Organization
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Legal Business Name | RALPH E CONNER D.O. INC
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 12/06/2007
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Provider Practice Location Address
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Address Line | 11460 TELEGRAPH RD
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City | SANTA FE SPRINGS
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State | CA
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Zip | 90670-3142
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Country | US
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Telephone | 562-864-1000
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Fax | 562-864-2125
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Provider Business Mailing Address
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Address Line | 11460 TELEGRAPH RD
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City | SANTA FE SPRINGS
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State | CA
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Zip | 90670-3142
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Country | US
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Telephone | 562-864-1000
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Fax | 562-864-2125
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | MS. MADONNA MANGUNNE
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Credential | PA-C
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Telephone | 562-864-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 20A6547
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License Number State | CA
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