Healthcare Provider Details

I. General information

NPI: 1568487858
Provider Name (Legal Business Name): RUBY SKINNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 12/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 S. STRATFORD AVENUE SUITE A
SANTA MARIA CA
93454
US

IV. Provider business mailing address

1400 E. CHURCH STREET ATTENTION: MEDICAL STAFF OFFICE
SANTA MARIA CA
93454
US

V. Phone/Fax

Practice location:
  • Phone: 805-332-8195
  • Fax: 805-332-8196
Mailing address:
  • Phone: 805-739-3954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG81701
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberG81701
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberG81701
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: