=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417351420
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY HEALTH INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2014
-----------------------------------------------------
Last Update Date | 10/31/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 225 E. AIRPORT DRIVE SUITE 145
-----------------------------------------------------
City | SAN BERNARDINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92408-3464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-888-5281
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 10065
-----------------------------------------------------
City | SAN BERNARDINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92423-0065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-888-5281
-----------------------------------------------------
Fax | 909-383-5686
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER/MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. ESTEBAN SANTE PONI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 909-888-5281
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | A93185
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------