Provider Demographics
NPI:1710200464
Name:RIDGECREST WOMEN'S MEDICAL PRACTICE
Entity Type:Organization
Organization Name:RIDGECREST WOMEN'S MEDICAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-446-3074
Mailing Address - Street 1:1041 N CHINA LAKE BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-3168
Mailing Address - Country:US
Mailing Address - Phone:760-446-3074
Mailing Address - Fax:
Practice Address - Street 1:1041 N CHINA LAKE BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3168
Practice Address - Country:US
Practice Address - Phone:760-446-3074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA109246261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty