Soeprono Medical Corporation

Primary specialty

Dermatopathology PhysicianTaxonomy code 207ND0900X

License

G28216 Issued in CA

Legal business name

SOEPRONO MEDICAL CORPORATION

Practice address

255 Terracina Blvd
Ste 206
Redlands, CA 92373-4870

Phone

(909) 792-8600

Fax

(909) 792-8660

NPI assigned

Aug 27, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Fred F Soeprono, M.D.NPI 1659485746

Title

President

Phone

(951) 203-5000

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Fred F Soeprono, M.D.

  • Dermatology Physician
  • Loma Linda, CA
  • NPI 1659485746
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346889600000",
    "number": "1306194261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1180",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923541180",
            "telephone_number": "909-792-8600",
            "fax_number": "909-792-8660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 TERRACINA BLVD",
            "address_2": "STE 206",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923734870",
            "telephone_number": "909-792-8600",
            "fax_number": "909-792-8660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOEPRONO MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-27",
        "last_updated": "2012-09-06",
        "status": "A",
        "authorized_official_last_name": "SOEPRONO",
        "authorized_official_first_name": "FRED",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "951-203-5000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ND0900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": "CA",
            "license": "G28216",
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "005D0573825",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marian Rose Sobretodo, FNP-C
• Socal Dental Specialists Dental Group of Dr. Ummethala
• Socal Specialty Care Medical Corporation
• Socalhealth Inc. Ipa
• Soda Dental Hygiene Practice of Ashley Shelley Rdhap, Inc.
• Albert I Sofyan
• Keren Happuch Bombeo Sola, LVN
• Christopher Solarte, PT, DPT
• Estevan Dario Solarte, M.D.
• Jasmine Sole

• Dermatopathology Physician in Redlands, CA
• Providers in Redlands, CA by specialty
• Dermatopathology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.