=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518169622
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEAN-BATEMAN MEDICAL GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 222 W 6TH STREET
-----------------------------------------------------
City | CORONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92882
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-734-2063
-----------------------------------------------------
Fax | 951-734-0256
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 222 W 6TH ST
-----------------------------------------------------
City | CORONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92882-3301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-734-2063
-----------------------------------------------------
Fax | 951-734-0256
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | RALPH D DEAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 951-734-2063
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | A25818
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------