Provider Demographics
NPI:1710396437
Name:MULLIGAN, RUTH (CMT)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:
Last Name:MULLIGAN
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 E FELLOWS DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-2856
Mailing Address - Country:US
Mailing Address - Phone:714-329-3028
Mailing Address - Fax:
Practice Address - Street 1:6200 E CANYON RIM RD
Practice Address - Street 2:SUITE 212
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-4317
Practice Address - Country:US
Practice Address - Phone:714-329-3028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist