Healthcare Provider Details

I. General information

NPI: 1447686985
Provider Name (Legal Business Name): RUTH FRIEDRICHSDORF M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2013
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 CAMINO ALTO STE 107
MILL VALLEY CA
94941-2910
US

IV. Provider business mailing address

31 SUNRISE AVE
MILL VALLEY CA
94941-3338
US

V. Phone/Fax

Practice location:
  • Phone: 415-388-6303
  • Fax: 415-388-7136
Mailing address:
  • Phone: 612-666-2096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA166767
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number60208
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: