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General NPI Number Information
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NPI Number | 1578208047
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Entity Type | Organization
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Legal Business Name | PREFERRED MEDICAL OFFICE INC
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Dates
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Enumeration Date | 04/29/2022
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Last Update Date | 08/04/2022
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Provider Practice Location Address
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Address Line | 710 BROOKSIDE AVE STE 9
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City | REDLANDS
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State | CA
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Zip | 92373-5181
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Country | US
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Telephone | 909-888-5281
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Fax |
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Provider Business Mailing Address
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Address Line | 710 BROOKSIDE AVE STE 9
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City | REDLANDS
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State | CA
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Zip | 92373-5181
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | ESTEBAN SANTE PONI
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Credential | MD
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Telephone | 909-644-4380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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