Provider Demographics
NPI:1497040752
Name:PETER J. RUTTI, M.D. INC.
Entity Type:Organization
Organization Name:PETER J. RUTTI, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUTTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-293-8846
Mailing Address - Street 1:2039 FOREST AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4817
Mailing Address - Country:US
Mailing Address - Phone:408-293-8846
Mailing Address - Fax:
Practice Address - Street 1:2039 FOREST AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4817
Practice Address - Country:US
Practice Address - Phone:408-293-8846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC36364332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC36364Medicare PIN