Healthcare Provider Details

I. General information

NPI: 1023367398
Provider Name (Legal Business Name): RAYMOND S. RUZICANO, M.D.INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2012
Last Update Date: 09/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 LA CASA VIA SUITE 345
WALNUT CREEK CA
94598-3091
US

IV. Provider business mailing address

112 LA CASA VIA SUITE 345
WALNUT CREEK CA
94598-3091
US

V. Phone/Fax

Practice location:
  • Phone: 925-943-1400
  • Fax:
Mailing address:
  • Phone: 925-943-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG33140
License Number StateCA

VIII. Authorized Official

Name: DR. RAYMONDR S RUZICANO
Title or Position: OWNER
Credential: MD
Phone: 925-943-1400