Provider Demographics
NPI:1023367398
Name:RAYMOND S. RUZICANO, M.D.INC
Entity Type:Organization
Organization Name:RAYMOND S. RUZICANO, M.D.INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMONDR
Authorized Official - Middle Name:S
Authorized Official - Last Name:RUZICANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-943-1400
Mailing Address - Street 1:112 LA CASA VIA
Mailing Address - Street 2:SUITE 345
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3091
Mailing Address - Country:US
Mailing Address - Phone:925-943-1400
Mailing Address - Fax:
Practice Address - Street 1:112 LA CASA VIA
Practice Address - Street 2:SUITE 345
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3091
Practice Address - Country:US
Practice Address - Phone:925-943-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-02
Last Update Date:2012-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG331402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G3314000Medicare PIN