Provider Demographics
NPI:1427266691
Name:FAKHOURY, RAMON (MD)
Entity type:Individual
Prefix:DR
First Name:RAMON
Middle Name:
Last Name:FAKHOURY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 579
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-0579
Mailing Address - Country:US
Mailing Address - Phone:951-270-0757
Mailing Address - Fax:
Practice Address - Street 1:1780 TOWN AND COUNTRY DR STE 103
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-3618
Practice Address - Country:US
Practice Address - Phone:951-270-0757
Practice Address - Fax:951-270-0759
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98772207Q00000X
OH35.089349207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1427266691Medicaid
1427266691Medicare UPIN
CA1427266691Medicare NSC
CA1427266691Medicaid
1427266691Medicare Oscar/Certification