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General NPI Number Information
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NPI Number | 1245281682
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Entity Type | Organization
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Legal Business Name | EDMUNDO RUIZ DAVILA, M.D.,INC.
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 02/25/2014
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Provider Practice Location Address
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Address Line | 4087 PERALTA BLVD
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City | FREMONT
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State | CA
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Zip | 94536-4849
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Country | US
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Telephone | 510-793-7555
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Fax | 510-797-5372
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Provider Business Mailing Address
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Address Line | 4087 PERALTA BLVD
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City | FREMONT
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State | CA
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Zip | 94536-4849
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Country | US
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Telephone | 510-793-7555
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Fax | 510-797-5372
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. LUCILLE JOANNE MENDOZA
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Credential |
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Telephone | 510-793-7555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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