Provider Demographics
NPI: | 1477546414 |
---|---|
Name: | BARRUGA, MENARD (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | MENARD |
Middle Name: | |
Last Name: | BARRUGA |
Suffix: | |
Gender: | M |
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: | 3006 S MARYLAND PKWY |
Mailing Address - Street 2: | 505 |
Mailing Address - City: | LAS VEGAS |
Mailing Address - State: | NV |
Mailing Address - Zip Code: | 89109-2218 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 702-697-0082 |
Mailing Address - Fax: | 702-369-5827 |
Practice Address - Street 1: | 26520 CACTUS AVE |
Practice Address - Street 2: | |
Practice Address - City: | MORENO VALLEY |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92555-3927 |
Practice Address - Country: | US |
Practice Address - Phone: | 888-350-2911 |
Practice Address - Fax: | 702-369-5827 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-08-24 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | G66243 | 208000000X, 2080P0203X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Not Answered | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | |
Not Answered | 2080P0203X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | 00G662432 | Medicare ID - Type Unspecified | |
CA | F85955 | Medicare UPIN |