Provider Demographics
NPI:1902376783
Name:INES RUTTY LLC
Entity Type:Organization
Organization Name:INES RUTTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:INES
Authorized Official - Middle Name:ALEJANDRA
Authorized Official - Last Name:SERRANO VILCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-251-9291
Mailing Address - Street 1:871 VINELAND RD STE B
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3938
Mailing Address - Country:US
Mailing Address - Phone:412-251-9291
Mailing Address - Fax:
Practice Address - Street 1:871 VINELAND RD STE B
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3938
Practice Address - Country:US
Practice Address - Phone:412-251-9291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty