Healthcare Provider Details

I. General information

NPI: 1295766947
Provider Name (Legal Business Name): US MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12679 BEACH BLVD
STANTON CA
90680-4007
US

IV. Provider business mailing address

12679 BEACH BLVD
STANTON CA
90680-4007
US

V. Phone/Fax

Practice location:
  • Phone: 714-379-8400
  • Fax:
Mailing address:
  • Phone: 714-379-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberW17922
License Number StateCA

VIII. Authorized Official

Name: DR. RICHARD DIETER RUTH
Title or Position: CEO
Credential: M.D.
Phone: 714-379-8400