Provider Demographics
NPI:1003385071
Name:UC SAN DIEGO HEALTH - RANCHO FAMILY MEDICAL GROUP
Entity Type:Organization
Organization Name:UC SAN DIEGO HEALTH - RANCHO FAMILY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, REVENUE & OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-249-6752
Mailing Address - Street 1:9300 CAMPUS POINT DRIVE
Mailing Address - Street 2:MAIL CODE 7970
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037
Mailing Address - Country:US
Mailing Address - Phone:858-249-6753
Mailing Address - Fax:
Practice Address - Street 1:28780 SINGLE OAK DR STE 160
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5528
Practice Address - Country:US
Practice Address - Phone:951-694-1753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGENTS OF THE UNIVERSITY OF CALIFORNIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty