MEDICARE: PATRICIA L RUCKLE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080A0000X	Pediatric Adolescent Medicine Physician	G51048	CA

General Provider Information

NPI Number	:	1538182241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA L RUCKLE MD

Provider Business Mailing Address
First Line	:	125 SURF WAY APT 332
Second Line	:
City	:	MONTEREY
State	:	CA
Zip	:	93940-3457
Country	:	US
Telephone Number	:	831-643-0238
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 GARDEN RD STE 110
Second Line	:
City	:	MONTEREY
State	:	CA
Zip	:	93940-5334
Country	:	US
Telephone Number	:	831-643-0238
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	03/18/2010

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Directions to “ PATRICIA L RUCKLE MD” Practice Location

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