Healthcare Provider Details

I. General information

NPI: 1669427506
Provider Name (Legal Business Name): CASTLE ROCK MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8705 COMPLEX DR
SAN DIEGO CA
92123-1401
US

IV. Provider business mailing address

8705 COMPLEX DR
SAN DIEGO CA
92123-1401
US

V. Phone/Fax

Practice location:
  • Phone: 858-565-6000
  • Fax: 858-627-0050
Mailing address:
  • Phone: 858-565-6000
  • Fax: 858-627-0050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RONALD LEROY GERTSCH
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 858-565-6000