Healthcare Provider Details

I. General information

NPI: 1730340241
Provider Name (Legal Business Name): MR. TERRANCE ALAN RUZICKA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 03/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18682 BEACH BLVD SUITE 140
HUNTINGTON BEACH CA
92648-2048
US

IV. Provider business mailing address

18682 BEACH BLVD SUITE 140
HUNTINGTON BEACH CA
92648-2048
US

V. Phone/Fax

Practice location:
  • Phone: 714-963-4300
  • Fax: 714-963-6768
Mailing address:
  • Phone: 714-963-4300
  • Fax: 714-963-6768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA 7253
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: