MEDICARE: RIALTO MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A70849	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00322599	OTHER	CA	MEDICARE RAILROAD

General Provider Information

NPI Number	:	1568598282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIALTO MEDICAL GROUP

Provider Business Mailing Address
First Line	:	4546 EL CAMINO REAL
Second Line	:	STE B-7
City	:	LOS ALTOS
State	:	CA
Zip	:	94022-1099
Country	:	US
Telephone Number	:	650-799-4659
Fax Number	:

Provider Business Practice Location Address
First Line	:	4546 EL CAMINO REAL
Second Line	:	STE B-7
City	:	LOS ALTOS
State	:	CA
Zip	:	94022-1099
Country	:	US
Telephone Number	:	650-799-4659
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEPAHNIE A HIGGINS
Credential	:	M.D.
Telephone Number	:	650-799-4659

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	02/28/2008

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Directions to “RIALTO MEDICAL GROUP ” Practice Location

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