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SHADOWRIDGE MEDICAL GROUP
NPI 1639398613
Specialist in Vista, CA

Active since April 25, 2007
1680 S MELROSE DR STE 105, VISTA, CA 92081(760) 727-6920(760) 727-3368 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 30, 2026.

About Shadowridge Medical Group NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHADOWRIDGE MEDICAL GROUP (NPI 1639398613) is a healthcare organization registered as a specialist in Vista, California and active in the NPI registry since April 2007. The organization lists Todd Wine, Physician, as its authorized official.

NPPES Registry Identity

NPI1639398613
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameSHADOWRIDGE MEDICAL GROUP
Location Address1680 S MELROSE DR STE 105Vista, CA 92081-5472
Mailing Address1680 S Melrose Dr Ste 105Vista, CA 92081-5472 · (760) 727-6920 · Fax (760) 727-3368
Phone(760) 727-6920
Fax(760) 727-3368
Organization SubpartNo
Authorized OfficialTodd WinePhysician · (760) 727-6920
Enumeration DateApril 25, 2007
Last NPPES UpdateAugust 22, 2020
✔ NPI 1639398613 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in CA · G045531
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
1680 S MELROSE DR STE 105, Vista, CA 92081
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

TAYLOR MARIE SCHIMMERS D.C.
Chiropractor
1680 S MELROSE DR STE 105
VISTA, CA 92081
San Diego County (760) 599-4900

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shadowridge Medical Group's NPI number?

The NPI number for Shadowridge Medical Group is 1639398613. It was assigned to this organization in the NPPES registry on April 25, 2007.

Where is Shadowridge Medical Group located?

Shadowridge Medical Group is located at 1680 S Melrose Dr Ste 105, Vista, CA 92081. The listed phone number is (760) 727-6920.

What is Shadowridge Medical Group's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

When was this NPI record last updated?

The NPPES record for Shadowridge Medical Group was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.