Healthcare Provider Details

I. General information

NPI: 1144222449
Provider Name (Legal Business Name): VIRGINIA RUTZ D.O.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 TILBURY DR.
KEARNY AZ
85237
US

IV. Provider business mailing address

PO BOX 369
KEARNY AZ
85237-0369
US

V. Phone/Fax

Practice location:
  • Phone: 520-363-5573
  • Fax: 520-363-5611
Mailing address:
  • Phone: 520-363-5573
  • Fax: 520-363-5611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3090
License Number StateAZ

VIII. Authorized Official

Name: MARY-LOUISE MULCAHY
Title or Position: ADMINISTRATOR
Credential: RN, MBA, BSN
Phone: 480-357-3904