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General NPI Number Information
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NPI Number | 1942181938
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Entity Type | Organization
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Legal Business Name | RIDGECREST MEDICAL GROUP INC
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Dates
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Enumeration Date | 09/08/2025
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 12233 LA MAIDA ST
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City | VALLEY VILLAGE
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State | CA
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Zip | 91607-3622
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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 | 25044 PEACHLAND AVE STE 209
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City | NEWHALL
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State | CA
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Zip | 91321-5751
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | SYUZANNA MARKOSYAN
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Credential | NP
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Telephone | 323-229-4217
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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