Provider Demographics
NPI:1801071964
Name:RSG MEDICAL CLINIC AND PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:RSG MEDICAL CLINIC AND PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:SOTELO
Authorized Official - Last Name:GUANZON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:6375-515-2058
Mailing Address - Street 1:MAYOMBO DISTRICT
Mailing Address - Street 2:SUITE # 1010 MEDICAL ARTS TOWER, DDVMH
Mailing Address - City:DAGUPAN
Mailing Address - State:PANGASINAN
Mailing Address - Zip Code:2400
Mailing Address - Country:PH
Mailing Address - Phone:6375-515-2058
Mailing Address - Fax:6375-515-8030
Practice Address - Street 1:MAYOMBO DISTRICT
Practice Address - Street 2:SUITE # 1010 MEDICAL ARTS TOWER, DDVMH
Practice Address - City:DAGUPAN
Practice Address - State:PANGASINAN
Practice Address - Zip Code:2400
Practice Address - Country:PH
Practice Address - Phone:6375-515-2058
Practice Address - Fax:6375-515-8030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No291U00000XLaboratoriesClinical Medical Laboratory