Healthcare Provider Details

I. General information

NPI: 1295672913
Provider Name (Legal Business Name): THE RIDGECREST MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12235 LA MAIDA ST
VALLEY VILLAGE CA
91607
US

IV. Provider business mailing address

116 1/2 CRYSTAL AVE
NEWPORT BEACH CA
92662-1380
US

V. Phone/Fax

Practice location:
  • Phone: 323-229-4217
  • Fax:
Mailing address:
  • Phone: 949-610-5240
  • Fax: 949-610-5240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL WENSLEY
Title or Position: OWNER
Credential: MD
Phone: 949-705-8226