Healthcare Provider Details

I. General information

NPI: 1538748025
Provider Name (Legal Business Name): RUI WILFREDO SOARES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2021
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 BROADWAY ST
REDWOOD CITY CA
94063-3132
US

IV. Provider business mailing address

430 BROADWAY ST
REDWOOD CITY CA
94063-3132
US

V. Phone/Fax

Practice location:
  • Phone: 650-721-1836
  • Fax:
Mailing address:
  • Phone: 650-721-1836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA206647
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: