Provider Demographics
NPI:1235112483
Name:RUTHRAUFF, BREANNA (MD)
Entity Type:Individual
Prefix:DR
First Name:BREANNA
Middle Name:
Last Name:RUTHRAUFF
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 1:2230 STOCKTON BLVD
Mailing Address - Street 2:DEPT OF PSYCHIATRY
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1419
Mailing Address - Country:US
Mailing Address - Phone:916-734-2972
Mailing Address - Fax:916-734-3384
Practice Address - Street 1:2230 STOCKTON BLVD
Practice Address - Street 2:DEPT OF PSYCHIATRY
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1419
Practice Address - Country:US
Practice Address - Phone:916-734-2972
Practice Address - Fax:916-734-3384
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA610212084N0400X, 2084P0800X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH35103Medicare UPIN