Provider Demographics
NPI:1255399341
Name:RITCHKEN, SIMON M (MD)
Entity type:Individual
Prefix:DR
First Name:SIMON
Middle Name:M
Last Name:RITCHKEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34151207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA34151AMedicare ID - Type UnspecifiedPERSONAL MEDICARE #
CAW7053Medicare ID - Type UnspecifiedPRACTICE MEDICARE #
CAA88052Medicare UPIN