Provider Demographics
NPI:1326579525
Name:RANCHO PHYSICIANS CHOICE A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:RANCHO PHYSICIANS CHOICE A MEDICAL CORPORATION
Other - Org Name:RANCHO CLINICA MEDICA FAMILIAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:RUIZ
Authorized Official - Last Name:DECRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-204-0909
Mailing Address - Street 1:1871 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-2601
Mailing Address - Country:US
Mailing Address - Phone:909-391-0022
Mailing Address - Fax:909-391-0026
Practice Address - Street 1:1871 E 4TH ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-2601
Practice Address - Country:US
Practice Address - Phone:909-391-0022
Practice Address - Fax:909-391-0026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-21
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty