Provider Demographics
NPI:1932384617
Name:RAMONA FAMILY MEDICAL OFFICE
Entity Type:Organization
Organization Name:RAMONA FAMILY MEDICAL OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-654-8132
Mailing Address - Street 1:1695 SOUTH SAN JACINTO AVE
Mailing Address - Street 2:SUITE L
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583-5103
Mailing Address - Country:US
Mailing Address - Phone:951-654-8132
Mailing Address - Fax:951-654-8135
Practice Address - Street 1:1695 SOUTH SAN JACINTO AVE
Practice Address - Street 2:SUITE L
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-5103
Practice Address - Country:US
Practice Address - Phone:951-654-8132
Practice Address - Fax:951-654-8135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24742261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center