Provider Demographics
NPI:1942181938
Name:RIDGECREST MEDICAL GROUP INC
Entity type:Organization
Organization Name:RIDGECREST MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:SYUZANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKOSYAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:323-229-4217
Mailing Address - Street 1:25044 PEACHLAND AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-5751
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12233 LA MAIDA ST
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3622
Practice Address - Country:US
Practice Address - Phone:323-229-4217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty