Healthcare Provider Details

I. General information

NPI: 1811710700
Provider Name (Legal Business Name): DAVID A RUSKIN MD A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31872 COAST HWY
LAGUNA BEACH CA
92651-6773
US

IV. Provider business mailing address

31872 COAST HWY
LAGUNA BEACH CA
92651-6773
US

V. Phone/Fax

Practice location:
  • Phone: 949-499-1311
  • Fax:
Mailing address:
  • Phone: 949-499-1311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID RUSKIN
Title or Position: OWNER
Credential: MD
Phone: 213-500-6995