Provider Demographics
NPI:1164511960
Name:GRUSD, RONALD SELWYN (MD DABR)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:SELWYN
Last Name:GRUSD
Suffix:
Gender:M
Credentials:MD DABR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8641 WILSHIRE BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2919
Mailing Address - Country:US
Mailing Address - Phone:310-289-8678
Mailing Address - Fax:
Practice Address - Street 1:8641 WILSHIRE BLVD STE 105
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2919
Practice Address - Country:US
Practice Address - Phone:310-289-8678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA327072085B0100X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A327072Medicaid
CAZZZ01724ZOtherMEDICARE PTAN
CAA26901Medicare UPIN
CA00A327072Medicaid