Provider Demographics
NPI:1407887375
Name:CML DEL VALLE MEDICAL GROUP
Entity Type:Organization
Organization Name:CML DEL VALLE MEDICAL GROUP
Other - Org Name:CENTRO MEDICO DEL VALLE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RATNIEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-871-0606
Mailing Address - Street 1:1151 E WASHINGTON AVE
Mailing Address - Street 2:STE C
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-2254
Mailing Address - Country:US
Mailing Address - Phone:760-871-0606
Mailing Address - Fax:760-871-3534
Practice Address - Street 1:1151 E WASHINGTON AVE
Practice Address - Street 2:STE C
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-2254
Practice Address - Country:US
Practice Address - Phone:760-871-0606
Practice Address - Fax:760-871-3534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42220261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17825Medicare ID - Type Unspecified