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General NPI Number Information
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NPI Number | 1467658310
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Entity Type | Organization
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Legal Business Name | QUE CARDIOLOGY MEDICAL GROUP
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 10/18/2007
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Provider Practice Location Address
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Address Line | 400 N PEPPER AVE
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City | COLTON
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State | CA
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Zip | 92324-1801
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Country | US
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Telephone | 909-580-6275
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Fax |
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Provider Business Mailing Address
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Address Line | 1510 SMILEY HEIGHTS DR
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City | REDLANDS
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State | CA
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Zip | 92373-6531
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Country | US
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Telephone | 909-792-7387
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAWRENCE DAVID RAPHAEL
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Credential | MD
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Telephone | 909-580-6275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | G33789
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License Number State | CA
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