Provider Demographics
NPI:1225040843
Name:CARRUTHERS, PAULA (MD)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:
Last Name:CARRUTHERS
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:PO BOX 54679
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90054-0679
Mailing Address - Country:US
Mailing Address - Phone:310-967-1884
Mailing Address - Fax:310-967-1744
Practice Address - Street 1:250 N ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1788
Practice Address - Country:US
Practice Address - Phone:310-967-1884
Practice Address - Fax:310-967-1744
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53801207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA22518Medicare UPIN