Provider Demographics
NPI:1619077013
Name:RSC MEDICAL GROUP, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:RSC MEDICAL GROUP, A PROFESSIONAL CORPORATION
Other - Org Name:EL PUERTO MEDICAL GROUP, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:SANGALANG
Authorized Official - Last Name:CASABAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-835-4000
Mailing Address - Street 1:1334 N AVALON BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-2639
Mailing Address - Country:US
Mailing Address - Phone:310-835-4000
Mailing Address - Fax:310-835-4012
Practice Address - Street 1:1334 N. AVALON BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-4516
Practice Address - Country:US
Practice Address - Phone:310-835-4000
Practice Address - Fax:310-835-4012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty