1043424971 NPI number — RAINBOW PEDIATRICS STEVE RANDAL E. FIRME, M.D., INC.

Table of content: DR. JENIFER C. FONG M.D. (NPI 1205925922)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043424971 NPI number — RAINBOW PEDIATRICS STEVE RANDAL E. FIRME, M.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAINBOW PEDIATRICS STEVE RANDAL E. FIRME, M.D., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043424971
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
980 E FOOTHILL BLVD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
UPLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91786-4056
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-981-5738
Provider Business Mailing Address Fax Number:
909-981-4577

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
980 E FOOTHILL BLVD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
UPLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91786-4056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-981-5738
Provider Business Practice Location Address Fax Number:
909-981-4577
Provider Enumeration Date:
05/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FIRME
Authorized Official First Name:
STEVE RANDAL
Authorized Official Middle Name:
EJERCITO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
909-981-5738

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  A056129 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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