Basic Information
| Provider Information | |||||||||
| NPI: | 1487915120 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RAFAEL LEMUS-RANGEL MD A MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25050 AVENUE KEARNY | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | VALENCIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913551255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6614300940 | ||||||||
| FaxNumber: | 6612950862 | ||||||||
| Practice Location | |||||||||
| Address1: | 1658 W AVENUE J | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935342814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619428855 | ||||||||
| FaxNumber: | 9726165118 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2012 | ||||||||
| LastUpdateDate: | 08/15/2016 | ||||||||
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| AuthorizedOfficialLastName: | LEMUS-RANGEL | ||||||||
| AuthorizedOfficialFirstName: | RAFAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6619428855 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | A107205 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | A107205 | 01 | CA | PRESIDENT MEDICAL STATE LICENSE NUMBER | OTHER |