Basic Information
| Provider Information | |||||||||
| NPI: | 1699851550 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAMOS | ||||||||
| FirstName: | TELESFORO | ||||||||
| MiddleName: | MONDARES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 685 CARNEGIE DR. | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924083583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098900407 | ||||||||
| FaxNumber: | 9098900575 | ||||||||
| Practice Location | |||||||||
| Address1: | 16455 MAIN STREET | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | HESPERIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609472161 | ||||||||
| FaxNumber: | 7609473673 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A31389 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A313890 | 01 | CA | MEDI-CAL | OTHER |