Healthcare Provider Details

I. General information

NPI: 1487758132
Provider Name (Legal Business Name): ALBERT RIDLOVSKY MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8112 MILLIKEN AVE SUITE 103-2
RANCHO CUCAMONGA CA
91730-7471
US

IV. Provider business mailing address

8112 MILLIKEN AVE SUITE 103-2
RANCHO CUCAMONGA CA
91730-7471
US

V. Phone/Fax

Practice location:
  • Phone: 909-481-0752
  • Fax: 909-481-0804
Mailing address:
  • Phone: 909-481-0752
  • Fax: 909-481-0804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA88847
License Number StateCA

VIII. Authorized Official

Name: ALBERT RIDLOVSKI
Title or Position: INTERNAL MEDICINE
Credential: M.D.
Phone: 909-481-0752