Provider Demographics
NPI:1093951444
Name:WEERASETHSIRI, RUNGTIWA (MD)
Entity Type:Individual
Prefix:DR
First Name:RUNGTIWA
Middle Name:
Last Name:WEERASETHSIRI
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 1:700 W OLIVE AVE STE D
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-2435
Mailing Address - Country:US
Mailing Address - Phone:209-383-1343
Mailing Address - Fax:209-383-5291
Practice Address - Street 1:700 W OLIVE AVE STE D
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-2435
Practice Address - Country:US
Practice Address - Phone:209-383-1343
Practice Address - Fax:209-383-5291
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2014-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106684208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1093951444Medicaid