Healthcare Provider Details

I. General information

NPI: 1992802680
Provider Name (Legal Business Name): ROFIM MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 E KATELLA AVE SUITE M
ORANGE CA
92867-5146
US

IV. Provider business mailing address

1920 E KATELLA AVE SUITE M
ORANGE CA
92867-5146
US

V. Phone/Fax

Practice location:
  • Phone: 714-633-7111
  • Fax: 714-633-2903
Mailing address:
  • Phone: 714-633-7111
  • Fax: 714-633-2903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG68455
License Number StateCA

VIII. Authorized Official

Name: DR. CARA BAILEY RUIZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-633-7111