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General NPI Number Information
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NPI Number | 1780917666
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Entity Type | Organization
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Legal Business Name | JAY A. FERNS D.O. A PROFESSIONAL MEDICAL CORP.
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Dates
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Enumeration Date | 09/10/2009
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Last Update Date | 09/10/2009
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Provider Practice Location Address
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Address Line | 29738 RANCHO CALIFORNIA ROAD SUITE B
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City | TEMECULA
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State | CA
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Zip | 92591
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Country | US
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Telephone | 951-308-1822
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Fax | 951-699-6734
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Provider Business Mailing Address
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Address Line | 29738 RANCHO CALIFORNIA ROAD SUITE B
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City | TEMECULA
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State | CA
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Zip | 92591
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Country | US
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Telephone | 951-308-1822
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Fax | 951-699-6734
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Authorized Official
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Title or Position | PHYSICAN
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Name | DR. JAY A FERNS
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Credential | D.O.
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Telephone | 951-308-1822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A6131
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License Number State | CA
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