Organization
QUE CARDIOLOGY MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAWRENCE DAVID RAPHAEL MD (OWNER)
(909) 580-6275
Entity
Organization
Contact information
Practice address
400 N PEPPER AVE, COLTON, CA 92324-1801
(909) 580-6275
Mailing address
1510 SMILEY HEIGHTS DR, REDLANDS, CA 92373-6531
(909) 792-7387
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
G33789
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZZ80336Z
—
CA
Enumeration date
06/26/2007
Last updated
10/18/2007
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