Provider Demographics
NPI:1598791600
Name:RANCHO FAMILY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:RANCHO FAMILY MEDICAL GROUP, INC.
Other - Org Name:TEMECULA VALLEY OBGYN MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LITCHFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-676-4193
Mailing Address - Street 1:28780 SINGLE OAK DR
Mailing Address - Street 2:STE 160
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-3625
Mailing Address - Country:US
Mailing Address - Phone:951-676-4193
Mailing Address - Fax:951-719-1469
Practice Address - Street 1:28780 SINGLE OAK DR
Practice Address - Street 2:STE 160
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-3625
Practice Address - Country:US
Practice Address - Phone:951-676-4193
Practice Address - Fax:951-719-1469
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RANCHO FAMILY MEDICAL GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-23
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ209702Medicare ID - Type Unspecified