Provider Demographics
NPI:1083611685
Name:SKULSKI, RYSZARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RYSZARD
Middle Name:
Last Name:SKULSKI
Suffix:
Gender:M
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:PO BOX 2011
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-1054
Mailing Address - Country:US
Mailing Address - Phone:760-773-0700
Mailing Address - Fax:760-773-0767
Practice Address - Street 1:39000 BOB HOPE DR
Practice Address - Street 2:SUITE K-302
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3221
Practice Address - Country:US
Practice Address - Phone:760-773-0700
Practice Address - Fax:760-773-0767
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77010207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A770100Medicaid
CAG16511Medicare UPIN
CA00A770101Medicare ID - Type Unspecified