Healthcare Provider Details

I. General information

NPI: 1629117809
Provider Name (Legal Business Name): RANCHO SANTA FE MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 WARING CT STE Q
OCEANSIDE CA
92056-4509
US

IV. Provider business mailing address

3230 WARING CT STE Q
OCEANSIDE CA
92056-4509
US

V. Phone/Fax

Practice location:
  • Phone: 760-591-9975
  • Fax: 760-591-9976
Mailing address:
  • Phone: 760-591-9975
  • Fax: 760-591-9976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License NumberRHC138799
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number05D0936324
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LUIS JOSEPH NAVAZO
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 760-591-9975