Healthcare Provider Details

I. General information

NPI: 1942181938
Provider Name (Legal Business Name): RIDGECREST MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12233 LA MAIDA ST
VALLEY VILLAGE CA
91607-3622
US

IV. Provider business mailing address

25044 PEACHLAND AVE STE 209
NEWHALL CA
91321-5751
US

V. Phone/Fax

Practice location:
  • Phone: 323-229-4217
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SYUZANNA MARKOSYAN
Title or Position: PRESIDENT & CEO
Credential: NP
Phone: 323-229-4217