Provider Demographics
NPI:1629019583
Name:RITHAPORN, RUTHACHAE (MD)
Entity Type:Individual
Prefix:DR
First Name:RUTHACHAE
Middle Name:
Last Name:RITHAPORN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:
Other - Last Name:RITHAPORN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1735 N FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-3031
Mailing Address - Country:US
Mailing Address - Phone:559-233-3322
Mailing Address - Fax:559-443-5200
Practice Address - Street 1:1735 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-3031
Practice Address - Country:US
Practice Address - Phone:559-233-3322
Practice Address - Fax:559-443-5200
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A342960174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA27441Medicare UPIN