Healthcare Provider Details

I. General information

NPI: 1457632028
Provider Name (Legal Business Name): RUTH RICHARDS L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11948 RIATA RD
LOWER LAKE CA
95457-9806
US

IV. Provider business mailing address

11948 RIATA RD
LOWER LAKE CA
95457-9806
US

V. Phone/Fax

Practice location:
  • Phone: 707-533-7086
  • Fax:
Mailing address:
  • Phone: 707-533-7086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC13986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: