MEDICARE: RANCHO PHYSICIANS CHOICE A MEDICAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician		CA

General Provider Information

NPI Number	:	1326579525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANCHO PHYSICIANS CHOICE A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	1871 E 4TH ST
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91764-2601
Country	:	US
Telephone Number	:	909-391-0022
Fax Number	:	909-391-0026

Provider Business Practice Location Address
First Line	:	1871 E 4TH ST
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91764-2601
Country	:	US
Telephone Number	:	909-391-0022
Fax Number	:	909-391-0026

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	LETICIA RUIZ DECRUZ
Credential	:
Telephone Number	:	951-204-0909

Provider Enumeration Date	:	03/21/2017
Last Update Date	:	10/27/2023

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