Provider Demographics
NPI:1750317970
Name:RANCHO FACULTY MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:RANCHO FACULTY MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-401-7161
Mailing Address - Street 1:7601 IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-3456
Mailing Address - Country:US
Mailing Address - Phone:562-803-0124
Mailing Address - Fax:562-803-5569
Practice Address - Street 1:7601 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-3456
Practice Address - Country:US
Practice Address - Phone:562-803-0124
Practice Address - Fax:562-803-5569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0057820Medicaid
CAZZZ40700ZOtherBLUE SHIELD LEGACY
CAHW11998EMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
CAW11998Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
CAZZZ40700ZOtherBLUE SHIELD LEGACY
CAHW11998DMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
CAGR0057820Medicaid
CAHW11998CMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
CAHW11998FMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
CAHW11998AMedicare ID - Type UnspecifiedMEDIARE GROUP NUMBER