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NPI Code Detail

MEDICARE: MR. EDUARDO DY RONQUILLO PA-C, PTA

MEDICARE: MR. EDUARDO DY RONQUILLO PA-C, PTA
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
1225200000XPhysical Therapy AssistantAT 6459CA
2363AS0400XSurgical Physician Assistant52160CA

General Provider Information

NPI Number : 1891833786
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. EDUARDO DY RONQUILLO PA-C, PTA
Provider Business Mailing Address
First Line : 1901 W LUGONIA AVE
Second Line : SUITE 120
City : REDLANDS
State : CA
Zip : 92374-9703
Country : US
Telephone Number : 909-557-1600
Fax Number : 909-557-1732
Provider Business Practice Location Address
First Line : 1901 W LUGONIA AVE
Second Line : SUITE 120
City : REDLANDS
State : CA
Zip : 92374-9703
Country : US
Telephone Number : 909-557-1600
Fax Number : 909-557-1732
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2007
Last Update Date : 12/27/2021

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