Organization
SOEPRONO MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FRED F SOEPRONO M.D. (PRESIDENT)
(951) 203-5000
Entity
Organization
Contact information
Practice address
255 TERRACINA BLVD, STE 206, REDLANDS, CA 92373-4870
(909) 792-8600
(909) 792-8660
Mailing address
PO BOX 1180, LOMA LINDA, CA 92354-1180
(909) 792-8600
(909) 792-8660
Taxonomy
Speciality
Code
Description
License number
State
207ND0900X
Dermatopathology Physician
Primary
G28216
CA
291U00000X
Clinical Medical Laboratory
005D0573825
CA
Other
Enumeration date
08/27/2012
Last updated
09/06/2012
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