Provider Demographics
NPI:1033397963
Name:RAHEL TEFERI RUIZ MD, INC.
Entity Type:Organization
Organization Name:RAHEL TEFERI RUIZ MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAHEL
Authorized Official - Middle Name:TEFERI
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-881-2192
Mailing Address - Street 1:18675 BUREN PL
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94552-5281
Mailing Address - Country:US
Mailing Address - Phone:510-881-2192
Mailing Address - Fax:510-363-8642
Practice Address - Street 1:18675 BUREN PL
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94552-5281
Practice Address - Country:US
Practice Address - Phone:510-881-2192
Practice Address - Fax:510-363-8642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA064304207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty