Provider Demographics
NPI:1457457103
Name:CORONA REGIONAL CARDIOLOGY AND EKG PANEL
Entity Type:Organization
Organization Name:CORONA REGIONAL CARDIOLOGY AND EKG PANEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILCOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHMING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-280-5350
Mailing Address - Street 1:PO BOX 2139
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92878-2139
Mailing Address - Country:US
Mailing Address - Phone:951-280-5350
Mailing Address - Fax:951-371-2804
Practice Address - Street 1:800 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-3420
Practice Address - Country:US
Practice Address - Phone:951-737-4343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ70146ZMedicare ID - Type Unspecified