Provider Demographics
NPI:1053381004
Name:RIDGE, NEAL PATRICK (DO)
Entity type:Individual
Prefix:DR
First Name:NEAL
Middle Name:PATRICK
Last Name:RIDGE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 986
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91908-0986
Mailing Address - Country:US
Mailing Address - Phone:559-707-2849
Mailing Address - Fax:
Practice Address - Street 1:230 PROSPECT PL STE 340B
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-1991
Practice Address - Country:US
Practice Address - Phone:619-522-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6920207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine