Healthcare Provider Details

I. General information

NPI: 1114114881
Provider Name (Legal Business Name): JACK J DRUET, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25495 MEDICAL CENTER DR SUITE 102
MURRIETA CA
92562-5963
US

IV. Provider business mailing address

43500 RIDGE PARK DR SUITE 102
TEMECULA CA
92590-3624
US

V. Phone/Fax

Practice location:
  • Phone: 951-506-9536
  • Fax: 951-693-4631
Mailing address:
  • Phone: 951-699-0303
  • Fax: 951-699-1145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG70999
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG70999
License Number StateCA

VIII. Authorized Official

Name: DR. JACK J DRUET
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 951-506-9536