Provider Demographics
NPI:1306199534
Name:RONALD S. GRUSD, M.D., INC.
Entity Type:Organization
Organization Name:RONALD S. GRUSD, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COLLECTIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUPPERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-289-8678
Mailing Address - Street 1:8641 WILSHIRE BLVD
Mailing Address - Street 2:105
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2900
Mailing Address - Country:US
Mailing Address - Phone:310-289-8678
Mailing Address - Fax:
Practice Address - Street 1:8641 WILSHIRE BLVD
Practice Address - Street 2:105
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2900
Practice Address - Country:US
Practice Address - Phone:310-289-8678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QR0200X, 261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile