Healthcare Provider Details

I. General information

NPI: 1679375273
Provider Name (Legal Business Name): CIFUENTES MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 E KATELLA AVE STE A
ORANGE CA
92867-5248
US

IV. Provider business mailing address

9842 BRILEY WAY
VILLA PARK CA
92861-3116
US

V. Phone/Fax

Practice location:
  • Phone: 949-209-5775
  • Fax: 949-209-5542
Mailing address:
  • Phone: 209-681-6227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RODRIGO KENNOSUKE CIFUENTES TESHIMA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 209-681-6227