MEDICARE: SOUTHERN ONTARIO 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	207Q00000X	Family Medicine Physician	A31364	CA

General Provider Information

NPI Number	:	1962518126
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN ONTARIO MEDICAL CENTER

Provider Business Mailing Address
First Line	:	2525 S EUCLID AVE
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91762-6620
Country	:	US
Telephone Number	:	909-986-2288
Fax Number	:	909-986-1892

Provider Business Practice Location Address
First Line	:	2525 S EUCLID AVE
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91762-6620
Country	:	US
Telephone Number	:	909-986-2288
Fax Number	:	909-986-1892

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHARLES YUAN HO
Credential	:	M.D.
Telephone Number	:	909-986-2288

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	02/05/2009

Similar Medicare Providers

1801902051 — DR. CHARLES YUAN HO M.D.
Practice Location Address:

2525 S EUCLID AVE
ONTARIO, CA
91762-6620

Practice Phone: 909-986-2288
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1235238783 — MR. NICHOLAS JOSEPH FITTANTE LMFT
Practice Location Address:

2545 S EUCLID AVE
ONTARIO, CA
91762-6620

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1851430573 — WAYNE NAKAMURA D.D.S.
Practice Location Address:

2523 S EUCLID AVE
ONTARIO, CA
91762-6620

Practice Phone: 909-983-0908
Practice Fax: 909-984-2833

1619151594 — MR. SAL CHRISTOPHER CHAVEZ MFT
Practice Location Address:

2553 S EUCLID AVE
ONTARIO, CA
91762-6620

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Practice Fax:

1972755924 — DR. FERDINAND MORALES LOPEZ DC
Practice Location Address:

2545 S EUCLID AVE
ONTARIO, CA
91762-6620

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1437390010 — MS. VICTORIA MARIE PAPPAS M.S.; M.F.T.
Practice Location Address:

2553 S EUCLID AVE
ONTARIO, CA
91762-6620

Practice Phone: 909-983-5575
Practice Fax: 909-983-1076

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