Healthcare Provider Details

I. General information

NPI: 1306379136
Provider Name (Legal Business Name): RUCHIRA DENSERT, M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2017
Last Update Date: 04/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5489 BOTHE AVE
SAN DIEGO CA
92122-4019
US

IV. Provider business mailing address

1350 COLUMBIA ST UNIT 800
SAN DIEGO CA
92101-3456
US

V. Phone/Fax

Practice location:
  • Phone: 760-978-7422
  • Fax:
Mailing address:
  • Phone: 760-978-7422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number133474
License Number StateCA

VIII. Authorized Official

Name: RUCHIRA DENSERT
Title or Position: PSYCHIATRIST
Credential: M.D.
Phone: 760-978-7422