Provider Demographics
NPI:1205825908
Name:RUZICKA, ROXANNE MARIE (MS)
Entity Type:Individual
Prefix:MS
First Name:ROXANNE
Middle Name:MARIE
Last Name:RUZICKA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8180 MANITOBA ST
Mailing Address - Street 2:#301
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-8644
Mailing Address - Country:US
Mailing Address - Phone:310-578-7274
Mailing Address - Fax:714-456-5330
Practice Address - Street 1:101 THE CITY DR S
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3201
Practice Address - Country:US
Practice Address - Phone:714-456-2340
Practice Address - Fax:714-456-5330
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS