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Organization
SHADOWRIDGE MEDICAL GROUP
Active
Organization
SHADOWRIDGE MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TODD WINE M.D. (PHYSICIAN)
(760) 727-6920
Entity
Organization
Contact information
Practice address
1680 S MELROSE DR STE 105, VISTA, CA 92081-5472
(760) 727-6920
(760) 727-3368
Mailing address
1680 S MELROSE DR STE 105, VISTA, CA 92081-5472
(760) 727-6920
(760) 727-3368
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G045531
CA
Other
Enumeration date
04/25/2007
Last updated
08/22/2020
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