Healthcare Provider Details

I. General information

NPI: 1922023993
Provider Name (Legal Business Name): PHILIP A RUSH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1844 SAN MIGUEL DR STE 310
WALNUT CREEK CA
94596-4963
US

IV. Provider business mailing address

1844 SAN MIGUEL DR STE 310
WALNUT CREEK CA
94596-4963
US

V. Phone/Fax

Practice location:
  • Phone: 925-937-6000
  • Fax: 925-937-2823
Mailing address:
  • Phone: 925-937-6000
  • Fax: 925-937-2823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG28043
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: