MEDICARE: RAMONA MEDICAL DIAGNOSTIC SERVICES INC

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	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1699717496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAMONA MEDICAL DIAGNOSTIC SERVICES INC

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

Provider Business Practice Location Address
First Line	:	1516 MAIN ST
Second Line	:	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	:	CEO
Name	:	MR. CHARLES FRALEY
Credential	:
Telephone Number	:	760-789-6118

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	08/22/2020

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