Healthcare Provider Details

I. General information

NPI: 1629019583
Provider Name (Legal Business Name): RUTHACHAE RITHAPORN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RICHARD RITHAPORN M.D.

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2814 CELESTE AVE
CLOVIS CA
93611-3431
US

IV. Provider business mailing address

2814 CELESTE AVE
CLOVIS CA
93611-3431
US

V. Phone/Fax

Practice location:
  • Phone: 559-916-5161
  • Fax: 559-896-8792
Mailing address:
  • Phone: 559-916-5161
  • Fax: 559-896-8792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number00A342960
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA342960
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: