Provider Demographics
NPI:1073680021
Name:RUTTENBERG, ALAN (MD INC)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:RUTTENBERG
Suffix:
Gender:M
Credentials:MD INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22048 SHERMAN WAY
Mailing Address - Street 2:STE. 214
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303
Mailing Address - Country:US
Mailing Address - Phone:818-888-8428
Mailing Address - Fax:818-888-8495
Practice Address - Street 1:22048 SHERMAN WAY
Practice Address - Street 2:STE. 214
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303
Practice Address - Country:US
Practice Address - Phone:818-888-8428
Practice Address - Fax:818-888-8495
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC274732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A33378Medicare UPIN
A33378Medicare UPIN
CAC274730Medicare ID - Type Unspecified