Healthcare Provider Details

I. General information

NPI: 1114583549
Provider Name (Legal Business Name): RUAHRENA CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2019
Last Update Date: 05/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3053 WEST OLYMPIC BOULEVARD SUITE 301
LOS ANGELES CA
90006
US

IV. Provider business mailing address

5042 WILSHIRE BLVD # 505
LOS ANGELES CA
90036-4305
US

V. Phone/Fax

Practice location:
  • Phone: 213-277-8008
  • Fax:
Mailing address:
  • Phone: 213-277-8008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: JOHN CHOI
Title or Position: ADMINISTRATOR
Credential:
Phone: 213-277-8008