Healthcare Provider Details

I. General information

NPI: 1245303122
Provider Name (Legal Business Name): MICHAEL NEALE RUTMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2341 S MELROSE DR
VISTA CA
92081-8788
US

IV. Provider business mailing address

2341 S MELROSE DR
VISTA CA
92081-8788
US

V. Phone/Fax

Practice location:
  • Phone: 760-598-0088
  • Fax: 760-598-0078
Mailing address:
  • Phone: 760-598-0088
  • Fax: 760-598-0078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A4641
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: