MEDICARE: ROFIM 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
1	208000000X	Pediatrics Physician	G68455	CA

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

General Provider Information

NPI Number	:	1992802680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROFIM MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	1920 E KATELLA AVE
Second Line	:	SUITE M
City	:	ORANGE
State	:	CA
Zip	:	92867-5146
Country	:	US
Telephone Number	:	714-633-7111
Fax Number	:	714-633-2903

Provider Business Practice Location Address
First Line	:	1920 E KATELLA AVE
Second Line	:	SUITE M
City	:	ORANGE
State	:	CA
Zip	:	92867-5146
Country	:	US
Telephone Number	:	714-633-7111
Fax Number	:	714-633-2903

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CARA BAILEY RUIZ
Credential	:	M.D.
Telephone Number	:	714-633-7111

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	08/22/2020

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Directions to “ROFIM MEDICAL GROUP, INC. ” Practice Location

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