Healthcare Provider Details

I. General information

NPI: 1639473820
Provider Name (Legal Business Name): RUTH LYNN CRAIG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2011
Last Update Date: 01/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 BELL WAVER WAY
OAKLAND CA
94619-2405
US

IV. Provider business mailing address

5 BELL WAVER WAY
OAKLAND CA
94619-2405
US

V. Phone/Fax

Practice location:
  • Phone: 510-531-0477
  • Fax: 510-530-3992
Mailing address:
  • Phone: 510-531-0477
  • Fax: 510-530-3992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberG55951
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: