Provider Demographics
NPI:1952486912
Name:WILLIAMSON, RUTH (MD)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:WILLIAMSON
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 1:4140 W 190TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:625 S FAIR OAKS AVE STE 100
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2640
Practice Address - Country:US
Practice Address - Phone:626-397-5149
Practice Address - Fax:310-397-2147
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG707B5C2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0087110Medicaid
CAHW14814Medicare ID - Type Unspecified
CAGR0087110Medicaid
G24435Medicare UPIN