MEDICARE: RANCHO FACULTY MEDICAL ASSOCIATES, 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
1	282N00000X	General Acute Care Hospital

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	ZZZ40700Z	OTHER	CA	BLUE SHIELD LEGACY

General Provider Information

NPI Number	:	1750317970
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANCHO FACULTY MEDICAL ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	7601 IMPERIAL HWY
Second Line	:
City	:	DOWNEY
State	:	CA
Zip	:	90242-3456
Country	:	US
Telephone Number	:	562-803-0124
Fax Number	:	562-803-5569

Provider Business Practice Location Address
First Line	:	7601 IMPERIAL HWY
Second Line	:
City	:	DOWNEY
State	:	CA
Zip	:	90242-3456
Country	:	US
Telephone Number	:	562-803-0124
Fax Number	:	562-803-5569

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	CHARLES STEWART
Credential	:	M.D.
Telephone Number	:	562-401-7161

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	02/27/2008

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