MEDICARE: RANCHO EASTERN MEDICAL CENTER

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	171100000X	Acupuncturist	AC12235	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AC12235	OTHER	CA	STATE LICENSE

General Provider Information

NPI Number	:	1407225246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANCHO EASTERN MEDICAL CENTER

Provider Business Mailing Address
First Line	:	6331 HAVEN AVE STE 7
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91737-6940
Country	:	US
Telephone Number	:	909-989-7388
Fax Number	:

Provider Business Practice Location Address
First Line	:	6331 HAVEN AVE STE 7
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91737-6940
Country	:	US
Telephone Number	:	909-989-7388
Fax Number	:

Authorized Official
Title or Position	:	L.AC
Name	:	FU HUA YANG
Credential	:
Telephone Number	:	909-989-7388

Provider Enumeration Date	:	09/23/2015
Last Update Date	:	09/23/2015

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Directions to “RANCHO EASTERN MEDICAL CENTER ” Practice Location

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