Healthcare Provider Details

I. General information

NPI: 1568541803
Provider Name (Legal Business Name): VICTOR LINCOLN RUTERBUSCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 SEA VILLAGE DR
CARDIFF BY THE SEA CA
92007-1440
US

IV. Provider business mailing address

1340 SEA VILLAGE DR
CARDIFF BY THE SEA CA
92007-1440
US

V. Phone/Fax

Practice location:
  • Phone: 760-566-8836
  • Fax:
Mailing address:
  • Phone: 760-566-8836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD15117
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC134507
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: