Healthcare Provider Details

I. General information

NPI: 1285674986
Provider Name (Legal Business Name): RICHARD L. RUFFALO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE HOAG DRIVE DEPARTMENT OF ANESTHESIOLOGY
NEWPORT BEACH CA
92663-4162
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-6954
  • Fax: 949-764-5674
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG64682
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: