Healthcare Provider Details

I. General information

NPI: 1740326578
Provider Name (Legal Business Name): ASTRID NORMA RUSQUELLAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2531 MARIN AVE
BERKELEY CA
94708-1442
US

IV. Provider business mailing address

2531 MARIN AVE
BERKELEY CA
94708-1442
US

V. Phone/Fax

Practice location:
  • Phone: 510-526-5465
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA35057
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: