Provider Demographics
NPI:1336243690
Name:RUBY JANE SIA MD INC
Entity Type:Organization
Organization Name:RUBY JANE SIA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:SIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-946-3888
Mailing Address - Street 1:16124 KASOTA RD
Mailing Address - Street 2:STE C
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307
Mailing Address - Country:US
Mailing Address - Phone:760-946-3888
Mailing Address - Fax:760-242-0388
Practice Address - Street 1:16124 KASOTA RD
Practice Address - Street 2:STE C
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307
Practice Address - Country:US
Practice Address - Phone:760-946-3888
Practice Address - Fax:760-242-0388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ27602ZMedicare ID - Type Unspecified