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General NPI Number Information
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NPI Number | 1295819639
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Entity Type | Organization
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Legal Business Name | ALPINE CREEK AND PINE VALLEY FAMILY MEDICINE INC.
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1347 TAVERN RD STE 9
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City | ALPINE
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State | CA
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Zip | 91901-3897
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Country | US
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Telephone | 619-445-0205
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Fax | 619-659-0205
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Provider Business Mailing Address
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Address Line | 1347 TAVERN RD STE 9
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City | ALPINE
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State | CA
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Zip | 91901-3897
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Country | US
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Telephone | 619-445-0205
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Fax | 619-659-0205
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Authorized Official
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Title or Position | CEO
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Name | JAMES M RICKETTS
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Credential | D.O.
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Telephone | 619-445-0204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 20A4384
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License Number State | CA
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