Provider Demographics
NPI:1518061860
Name:SIA, RUBY JANE (MD)
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:JANE
Last Name:SIA
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 1:16008 TUSCOLA RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-1320
Mailing Address - Country:US
Mailing Address - Phone:760-946-3888
Mailing Address - Fax:760-242-0388
Practice Address - Street 1:16008 TUSCOLA ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1320
Practice Address - Country:US
Practice Address - Phone:760-946-3888
Practice Address - Fax:760-242-0388
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63962207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA030510778OtherTRICARE
CA00A639620Medicaid
CA00A639620Medicaid
CA00A639621Medicare ID - Type Unspecified