Provider Demographics
NPI:1881779296
Name:KRUTZIK, RAMONA ALICIA (MD)
Entity type:Individual
Prefix:DR
First Name:RAMONA
Middle Name:ALICIA
Last Name:KRUTZIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RAMONA
Other - Middle Name:ALICIA
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:528 G ST
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-2411
Mailing Address - Country:US
Mailing Address - Phone:760-344-6355
Mailing Address - Fax:760-344-6921
Practice Address - Street 1:528 G ST
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-2411
Practice Address - Country:US
Practice Address - Phone:760-344-1881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70812207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A708120Medicaid
CA00A708120Medicaid
CAW21299Medicare PIN