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General NPI Number Information
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NPI Number | 1346441276
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Entity Type | Organization
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Legal Business Name | FRED F. SOEPRONO, M.D., INC.
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 12/07/2021
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Provider Practice Location Address
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Address Line | 255 TERRACINA BLVD SUITE 206
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City | REDLANDS
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State | CA
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Zip | 92373-4870
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Country | US
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Telephone | 909-792-8600
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Fax | 909-792-8660
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Provider Business Mailing Address
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Address Line | 255 TERRACINA BLVD STE 206
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City | REDLANDS
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State | CA
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Zip | 92373-4870
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Country | US
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Telephone | 909-792-8600
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Fax | 909-792-8660
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. RONNIE NATHAN DAWOOD
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Credential | MD
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Telephone | 949-367-1115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State | CA
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