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NPI Code Detail

MEDICARE: V-TACH MEDICAL GROUP INC.

MEDICARE: V-TACH MEDICAL GROUP INC.
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
1261QP2300XPrimary Care Clinic/CenterAO50272CA

General Provider Information

NPI Number : 1578501110
Entity Type Code : Organization
Provider Name (Legal Business Name) : V-TACH MEDICAL GROUP INC.
Provider Business Mailing Address
First Line : 506 16TH ST
Second Line :
City : HUNTINGTON BEACH
State : CA
Zip : 92648-4014
Country : US
Telephone Number : 714-374-9111
Fax Number : 714-374-7311
Provider Business Practice Location Address
First Line : 301 VICTORIA ST
Second Line :
City : COSTA MESA
State : CA
Zip : 92627-1995
Country : US
Telephone Number : 949-642-2734
Fax Number :
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : DR. KENNETH RICH
Credential : M.D.
Telephone Number : 714-747-5050
Provider Enumeration Date : 06/04/2006
Last Update Date : 09/06/2023

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