Provider Demographics
NPI:1346392875
Name:RALPH E CONNER D.O. INC
Entity Type:Organization
Organization Name:RALPH E CONNER D.O. INC
Other - Org Name:SANTA FE PRINGS URGENT CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:MADONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGUNNE
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:562-864-1000
Mailing Address - Street 1:11460 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-3142
Mailing Address - Country:US
Mailing Address - Phone:562-864-1000
Mailing Address - Fax:562-864-2125
Practice Address - Street 1:11460 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-3142
Practice Address - Country:US
Practice Address - Phone:562-864-1000
Practice Address - Fax:562-864-2125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6547261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF91204Medicare UPIN
CAW15500Medicare PIN