Healthcare Provider Details

I. General information

NPI: 1306862701
Provider Name (Legal Business Name): LUCILLE RIDGILL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28729 ATFORD DR
RANCHO PALOS VERDES CA
90275-6515
US

IV. Provider business mailing address

28729 ATFORD DR
RANCHO PALOS VERDES CA
90275-6515
US

V. Phone/Fax

Practice location:
  • Phone: 310-218-8816
  • Fax:
Mailing address:
  • Phone: 310-218-8816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG45977
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberG45977
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: