Organization
ALPINE CREEK AND PINE VALLEY FAMILY MEDICINE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES M RICKETTS D.O. (CEO)
(619) 445-0204
Entity
Organization
Contact information
Practice address
1347 TAVERN RD STE 9, ALPINE, CA 91901-3897
(619) 445-0205
(619) 659-0205
Mailing address
1347 TAVERN RD STE 9, ALPINE, CA 91901-3897
(619) 445-0205
(619) 659-0205
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
Primary
20A4384
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00AX43840
—
CA
05
—
00AX62390
—
CA
01
—
ZZZ48102Z
BLUE SHIELD
CA
Enumeration date
10/24/2006
Last updated
08/22/2020
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