Provider Demographics
NPI:1598819898
Name:RITCHKEN AND FIRST MEDICAL GROUP
Entity Type:Organization
Organization Name:RITCHKEN AND FIRST MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIBEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-292-0108
Mailing Address - Street 1:4282 GENESEE AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-4961
Mailing Address - Country:US
Mailing Address - Phone:858-292-0108
Mailing Address - Fax:858-292-9097
Practice Address - Street 1:4282 GENESEE AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-4961
Practice Address - Country:US
Practice Address - Phone:858-292-0108
Practice Address - Fax:858-292-9097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33952261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W7053Medicare PIN