Provider Demographics
NPI:1235265505
Name:RANCHO CAPISTRANO MEDICAL CLINIC,INC
Entity Type:Organization
Organization Name:RANCHO CAPISTRANO MEDICAL CLINIC,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHILPA
Authorized Official - Middle Name:JAGDISH
Authorized Official - Last Name:GAIKWAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-240-2555
Mailing Address - Street 1:34052 LA PLZ STE 103
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-2571
Mailing Address - Country:US
Mailing Address - Phone:949-240-2555
Mailing Address - Fax:949-240-2121
Practice Address - Street 1:34052 LA PLZ STE 103
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-2571
Practice Address - Country:US
Practice Address - Phone:949-240-2555
Practice Address - Fax:949-240-2121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17275Medicare ID - Type Unspecified
Y09874Medicare UPIN