Healthcare Provider Details

I. General information

NPI: 1073825766
Provider Name (Legal Business Name): RUZMED INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2010
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 LUSITANA ST 804
HONOLULU HI
96813-2449
US

IV. Provider business mailing address

2658 GRIFFITH PARK BLVD STE 180
LOS ANGELES CA
90039-2520
US

V. Phone/Fax

Practice location:
  • Phone: 888-624-6514
  • Fax:
Mailing address:
  • Phone: 888-624-6514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number12D0620374
License Number StateHI

VIII. Authorized Official

Name: RICHARD M GOODALE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 888-624-6514