Healthcare Provider Details

I. General information

NPI: 1558107698
Provider Name (Legal Business Name): RGTACS INC PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 10/19/2024
Certification Date: 10/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 CONSTITUTION BLVD
SALINAS CA
93906-3100
US

IV. Provider business mailing address

1202 N 24TH ST
BOISE ID
83702-2303
US

V. Phone/Fax

Practice location:
  • Phone: 831-755-4111
  • Fax:
Mailing address:
  • Phone:
  • Fax: 626-403-0321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RASHNA GINWALLA
Title or Position: PRESIDENT
Credential: MD
Phone: 215-901-4908