Healthcare Provider Details

I. General information

NPI: 1922112358
Provider Name (Legal Business Name): RUI A DA SILVA, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58471 29 PALMS HWY SUITE 203
YUCCA VALLEY CA
92284-5818
US

IV. Provider business mailing address

58471 29 PALMS HWY SUITE 203
YUCCA VALLEY CA
92284-5818
US

V. Phone/Fax

Practice location:
  • Phone: 760-365-7651
  • Fax: 760-365-6050
Mailing address:
  • Phone: 760-365-7651
  • Fax: 760-365-6050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA897170
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA33298
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA33298
License Number StateCA

VIII. Authorized Official

Name: DR. RUI ANTHONY DA SILVA
Title or Position: PRESIDENT
Credential: MD
Phone: 760-365-7651