Provider Demographics
NPI:1578619649
Name:RUSH, AURILLA N (MD)
Entity Type:Individual
Prefix:
First Name:AURILLA
Middle Name:N
Last Name:RUSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:AURILLA
Other - Middle Name:
Other - Last Name:SURDYKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16850 BEAR VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-5794
Mailing Address - Country:US
Mailing Address - Phone:760-241-8000
Mailing Address - Fax:
Practice Address - Street 1:23375 WAALEW RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-6917
Practice Address - Country:US
Practice Address - Phone:760-985-7781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61071207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00192626OtherRAILROAD
CA00G610710Medicaid
CA00G610710Medicaid
CAP00192626OtherRAILROAD