MEDICARE: RAMONA MEDICAL DIAGNOSTIC SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1043372139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAMONA MEDICAL DIAGNOSTIC SERVICES

Provider Business Mailing Address
First Line	:	1516 MAIN ST
Second Line	:	SUITE 103
City	:	RAMONA
State	:	CA
Zip	:	92065-5242
Country	:	US
Telephone Number	:	760-789-6118
Fax Number	:	760-788-2068

Provider Business Practice Location Address
First Line	:	1516 MAIN ST
Second Line	:	SUITE 103
City	:	RAMONA
State	:	CA
Zip	:	92065-5242
Country	:	US
Telephone Number	:	760-789-6118
Fax Number	:	760-788-2068

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. CHARLES FRALEY
Credential	:
Telephone Number	:	760-789-6118

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	08/22/2020

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Directions to “RAMONA MEDICAL DIAGNOSTIC SERVICES ” Practice Location

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