Provider Demographics
NPI:1073559910
Name:HODDINOTT, RUTH ELAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:ELAINE
Last Name:HODDINOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 SULLIVAN AVE RM 606
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2226
Mailing Address - Country:US
Mailing Address - Phone:650-301-0500
Mailing Address - Fax:650-994-2716
Practice Address - Street 1:1800 SULLIVAN AVE RM 606
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2226
Practice Address - Country:US
Practice Address - Phone:650-301-0500
Practice Address - Fax:650-994-2716
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42681207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA49068Medicare UPIN