Healthcare Provider Details

I. General information

NPI: 1336284074
Provider Name (Legal Business Name): RITTA M GHARIB P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 VALLEY CENTRE DR MAIL DROP S99
SAN DIEGO CA
92130-1111
US

IV. Provider business mailing address

FILE# 54433 SUITE #409
LOS ANGELES CA
90074-4433
US

V. Phone/Fax

Practice location:
  • Phone: 858-764-3280
  • Fax: 858-764-3299
Mailing address:
  • Phone: 858-784-5888
  • Fax: 858-784-5960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA15121
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: