Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Shadowridge Medical Group

Organization Specialist · NPI 1639398613

Shadowridge Medical Group is a Specialist in Vista, California. Licensed in California. Registered with an NPI since 2007.

Licensed in
CA
In the registry since
2007

Practice location Address checks out

1680 S Melrose Dr Ste 105
Vista, CA 92081-5472
Phone: (760) 727-6920
Fax: (760) 727-3368
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Specialist (primary) Taxonomy 174400000X · Licence G045531 (CA)

Record details

NPI number1639398613
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Todd Wine — Physician · (760) 727-6920
NPI enumeratedApril 25, 2007
Last updated in NPPESAugust 22, 2020
Mailing address1680 S Melrose Dr Ste 105, Vista, CA 92081-5472

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