Provider Demographics
NPI:1245409598
Name:RUTH HASKINS, MD, INC.
Entity Type:Organization
Organization Name:RUTH HASKINS, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:HASKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-817-2649
Mailing Address - Street 1:3444 SMOKEY MOUNTAIN CIR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-7326
Mailing Address - Country:US
Mailing Address - Phone:916-941-0779
Mailing Address - Fax:
Practice Address - Street 1:1611 CREEKSIDE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3490
Practice Address - Country:US
Practice Address - Phone:916-817-2649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG064514207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3065000OtherSTATE, CORPORATION NUMBER