Healthcare Provider Details

I. General information

NPI: 1689785834
Provider Name (Legal Business Name): ALEXANDER RUCHENKOV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/20/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11670 ATWOOD RD
AUBURN CA
95603-9522
US

IV. Provider business mailing address

11670 ATWOOD RD
AUBURN CA
95603-9522
US

V. Phone/Fax

Practice location:
  • Phone: 530-887-2810
  • Fax:
Mailing address:
  • Phone: 530-887-2810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA81662
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: