Provider Demographics
NPI:1811062508
Name:RUZICANO, RAYMOND S (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:S
Last Name:RUZICANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:112 LA CASA VIA
Mailing Address - Street 2:SUITE 345
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3091
Mailing Address - Country:US
Mailing Address - Phone:925-943-1400
Mailing Address - Fax:925-946-1463
Practice Address - Street 1:112 LA CASA VIA
Practice Address - Street 2:SUITE 345
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3091
Practice Address - Country:US
Practice Address - Phone:925-943-1400
Practice Address - Fax:925-946-1463
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG331402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR00G331400Medicare ID - Type UnspecifiedMEDICARE