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General NPI Number Information
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NPI Number | 1003430299
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Entity Type | Organization
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Legal Business Name | INNOVATIVE TREATMENT ASSOCIATES INC
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Dates
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Enumeration Date | 06/03/2020
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Last Update Date | 06/03/2020
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Provider Practice Location Address
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Address Line | 3581 PALMER DR STE 601
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City | CAMERON PARK
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State | CA
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Zip | 95682-8238
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Country | US
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Telephone | 530-391-9196
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Fax |
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Provider Business Mailing Address
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Address Line | 3031 CINSANT DR UNIT 2
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City | CAMERON PARK
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State | CA
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Zip | 95682-7004
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Country | US
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Telephone | 530-391-9196
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN ALLEN RULISON
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Credential | MD
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Telephone | 530-391-9196
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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