Provider Demographics
NPI:1205873197
Name:GILBOA, RUTH (MD)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:GILBOA
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 1:3629 VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056
Mailing Address - Country:US
Mailing Address - Phone:760-757-7546
Mailing Address - Fax:760-828-9138
Practice Address - Street 1:530 LOMAS SANTA FE DR STE D
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1346
Practice Address - Country:US
Practice Address - Phone:858-259-0056
Practice Address - Fax:858-259-0787
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46557207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A465570Medicare ID - Type UnspecifiedMEDICARE NORTH
CAWA46557A,C,DMedicare ID - Type UnspecifiedMEDICARE SO
E49917Medicare UPIN