Provider Demographics
NPI:1578208047
Name:PREFERRED MEDICAL OFFICE INC
Entity Type:Organization
Organization Name:PREFERRED MEDICAL OFFICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ESTEBAN
Authorized Official - Middle Name:SANTE
Authorized Official - Last Name:PONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-644-4380
Mailing Address - Street 1:710 BROOKSIDE AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5181
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:710 BROOKSIDE AVE STE 9
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5181
Practice Address - Country:US
Practice Address - Phone:909-888-5281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-29
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty