Provider Demographics
NPI:1629117809
Name:RANCHO SANTA FE MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:RANCHO SANTA FE MEDICAL GROUP, INC.
Other - Org Name:MOBILE DOCTOR MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:NAVAZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-591-9975
Mailing Address - Street 1:3230 WARING CT STE Q
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4509
Mailing Address - Country:US
Mailing Address - Phone:760-591-9975
Mailing Address - Fax:760-591-9976
Practice Address - Street 1:3230 WARING CT STE Q
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4509
Practice Address - Country:US
Practice Address - Phone:760-591-9975
Practice Address - Fax:760-591-9976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 213E00000X
CARHC1387992471C3402X
CA05D0936324291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G729400Medicaid
CAZZZ553802OtherBCBS
CAZZZ553802OtherBCBS
CA00G729400Medicaid