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Organization
RETINAL CONSULTANTS OF SOUTHERN CALIFORNIA MEDICAL GROUP, INC
Active
Organization
RETINAL CONSULTANTS OF SOUTHERN CALIFORNIA MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH ROBERT DIDDIE MD (PRESIDENT)
(805) 379-0200
Entity
Organization
Contact information
Practice address
1220 LA VENTA DR, SUITE 211, WESTLAKE VILLAGE, CA 91361-3703
(805) 379-0200
(805) 496-5204
Mailing address
1220 LA VENTA DR, SUITE 211, WESTLAKE VILLAGE, CA 91361-3703
(805) 379-0200
(805) 496-5204
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G33939
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G339391
—
CA
01
—
CP5288
RAILROAD MEDICARE
CA
Enumeration date
07/22/2006
Last updated
09/26/2023
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