Fred F. Soeprono, M.D., Inc.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

FRED F. SOEPRONO, M.D., INC.

Practice address

255 Terracina Blvd
Suite 206
Redlands, CA 92373-4870

Phone

(909) 792-8600

Fax

(909) 792-8660

NPI assigned

May 29, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Ronnie Nathan Dawood, MDNPI 1851593065

Title

Physician

Phone

(949) 367-1115

Specialties & licenses 1

Addresses

Other names 2

• Advanced Dermatology and Laser Center Doing business as
• Advanced Dermatology & Laser Center Other name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Sublime MD, a Professional Medical Corporation

  • Dermatology Physician
  • Redlands, CA
  • NPI 1396400230

  Member Of

  NPD member

Practitioners 1

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

• Ronnie Nathan Dawood, M.D.

  • Internal Medicine Physician
  • Mission Viejo, CA
  • NPI 1851593065

  Multi-Specialty

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1180396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638835200000",
    "number": "1346441276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 TERRACINA BLVD STE 206",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923734870",
            "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": "SUITE 206",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923734870",
            "telephone_number": "909-792-8600",
            "fax_number": "909-792-8660"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7095 Indiana Ave Ste 210",
            "address_purpose": "LOCATION",
            "city": "Riverside",
            "state": "CA",
            "postal_code": "925064159",
            "country_code": "US",
            "telephone_number": "951-218-9910",
            "fax_number": "909-792-8660",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FRED F. SOEPRONO, M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-29",
        "last_updated": "2021-12-07",
        "certification_date": "2021-12-07",
        "status": "A",
        "authorized_official_last_name": "DAWOOD",
        "authorized_official_first_name": "RONNIE",
        "authorized_official_middle_name": "NATHAN",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "949-367-1115",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.sublimemdinfo@gmail.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "address_1": "255 Terracina Blvd",
            "address_2": "Suite 206",
            "city": "Redlands",
            "state": "CA",
            "country_code": "US",
            "postal_code": "923734870",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Advanced Dermatology and Laser Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Advanced Dermatology & Laser Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Emma Franklin
• Sarah Franklin
• Heather Anne Fraser, LCSW
• Fratt Dental Corporation
• Maria Elena Frausto
• Frederick L. Hoffer, a Professional Dental Corp.
• Connor James Frerichs, DPT
• Fresh Approach Nutrition, Inc.
• Lynaia Kathleen Freund, LMFT
• Calvin A Fritzsche, D.D.S., F.A.A.C.P.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2021; 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.