Healthcare Provider Details

I. General information

NPI: 1730992942
Provider Name (Legal Business Name): HALEY RUSTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

564 MOUNTAIN RANCH RD # 5
SAN ANDREAS CA
95249-9782
US

IV. Provider business mailing address

PO BOX 1629
SAN ANDREAS CA
95249-1629
US

V. Phone/Fax

Practice location:
  • Phone: 209-498-2227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: