Healthcare Provider Details

I. General information

NPI: 1306364484
Provider Name (Legal Business Name): RUTH BURGIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 09/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 HOMESTEAD RD STE A
LOS ALTOS CA
94024-7300
US

IV. Provider business mailing address

1825 GRANGER AVE
LOS ALTOS CA
94024-6716
US

V. Phone/Fax

Practice location:
  • Phone: 408-774-0134
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number58117
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: