Basic Information
Provider Information | |||||||||
NPI: | 1235196718 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ORNELAS | ||||||||
FirstName: | FRANCISCO | ||||||||
MiddleName: | R. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: | JR. | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 660305 | ||||||||
Address2: |   | ||||||||
City: | ARCADIA | ||||||||
State: | CA | ||||||||
PostalCode: | 910660305 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6264470206 | ||||||||
FaxNumber: | 6264476057 | ||||||||
Practice Location | |||||||||
Address1: | 5451 WALNUT AVE | ||||||||
Address2: |   | ||||||||
City: | CHINO | ||||||||
State: | CA | ||||||||
PostalCode: | 917102609 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9094648666 | ||||||||
FaxNumber: | 9094648913 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/27/2006 | ||||||||
LastUpdateDate: | 04/18/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | A60144 | CA | N |   | Other Service Providers | Specialist |   | 207P00000X | A60144 | CA | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
ID Information
ID | Type | State | Issuer | Description | A60144 | 01 | CA | MEDICAL LICENSE | OTHER | 00A601440 | 05 | CA |   | MEDICAID |