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General NPI Number Information
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NPI Number | 1932384617
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Entity Type | Organization
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Legal Business Name | RAMONA FAMILY MEDICAL OFFICE
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Dates
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Enumeration Date | 12/31/2007
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Last Update Date | 02/25/2011
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Provider Practice Location Address
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Address Line | 1695 SOUTH SAN JACINTO AVE SUITE L
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City | SAN JACINTO
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State | CA
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Zip | 92583-5103
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Country | US
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Telephone | 951-654-8132
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Fax | 951-654-8135
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Provider Business Mailing Address
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Address Line | 1695 SOUTH SAN JACINTO AVE SUITE L
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City | SAN JACINTO
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State | CA
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Zip | 92583-5103
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Country | US
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Telephone | 951-654-8132
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Fax | 951-654-8135
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS LEE BROWN
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Credential | M.D.
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Telephone | 951-654-8132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 24742
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License Number State | CA
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