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General NPI Number Information
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NPI Number | 1295672913
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Entity Type | Organization
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Legal Business Name | THE RIDGECREST MEDICAL GROUP PC
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Dates
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Enumeration Date | 04/30/2026
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Last Update Date | 04/30/2026
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Provider Practice Location Address
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Address Line | 12235 LA MAIDA ST
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City | VALLEY VILLAGE
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State | CA
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Zip | 91607
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Country | US
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Telephone | 323-229-4217
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Fax |
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Provider Business Mailing Address
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Address Line | 116 1/2 CRYSTAL AVE
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City | NEWPORT BEACH
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State | CA
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Zip | 92662-1380
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Country | US
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Telephone | 949-610-5240
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Fax | 949-610-5240
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL WENSLEY
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Credential | MD
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Telephone | 949-705-8226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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