Healthcare Provider Details

I. General information

NPI: 1366573453
Provider Name (Legal Business Name): RAYMOND JOHN HRUBY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 E 2ND ST
POMONA CA
91766-1854
US

IV. Provider business mailing address

11115 HILLSIDE RD
ALTA LOMA CA
91737-1806
US

V. Phone/Fax

Practice location:
  • Phone: 909-469-5279
  • Fax: 909-469-5289
Mailing address:
  • Phone: 909-466-8332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number20A4620
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A4620
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: