Healthcare Provider Details

I. General information

NPI: 1922216647
Provider Name (Legal Business Name): SANTA RITA MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 SAN BERNARDINO ST STE 202
MONTCLAIR CA
91763-2328
US

IV. Provider business mailing address

4950 SAN BERNARDINO ST STE 202
MONTCLAIR CA
91763-2328
US

V. Phone/Fax

Practice location:
  • Phone: 909-626-8262
  • Fax: 909-626-8272
Mailing address:
  • Phone: 909-626-8262
  • Fax: 909-626-8272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA44599
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberC41437
License Number StateCA

VIII. Authorized Official

Name: PHILLIP ADRIAN RUIZ
Title or Position: CEO, CFO
Credential: MD
Phone: 323-359-9204