Healthcare Provider Details

I. General information

NPI: 1407887375
Provider Name (Legal Business Name): CML DEL VALLE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 E WASHINGTON AVE STE C
ESCONDIDO CA
92025-2254
US

IV. Provider business mailing address

1151 E WASHINGTON AVE STE C
ESCONDIDO CA
92025-2254
US

V. Phone/Fax

Practice location:
  • Phone: 760-871-0606
  • Fax: 760-871-3534
Mailing address:
  • Phone: 760-871-0606
  • Fax: 760-871-3534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberC42220
License Number StateCA

VIII. Authorized Official

Name: DR. ALFREDO RATNIEWSKI
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 760-871-0606