Provider Demographics
NPI:1942385505
Name:MENOR, RAMONCHITO PERALTA (MD)
Entity Type:Individual
Prefix:
First Name:RAMONCHITO
Middle Name:PERALTA
Last Name:MENOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 W CHERRY AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3506
Mailing Address - Country:US
Mailing Address - Phone:559-781-7980
Mailing Address - Fax:559-788-0544
Practice Address - Street 1:198 W CHERRY AVE
Practice Address - Street 2:UNIT A
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3506
Practice Address - Country:US
Practice Address - Phone:559-781-7980
Practice Address - Fax:559-788-0544
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2021-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56095207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG29176Medicare UPIN