=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598032385
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JON J RUSCIANO MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2011
-----------------------------------------------------
Last Update Date | 01/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 144 STONY POINT RD
-----------------------------------------------------
City | SANTA ROSA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95401-4122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-521-4500
-----------------------------------------------------
Fax | 707-521-4685
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 144 STONY POINT RD
-----------------------------------------------------
City | SANTA ROSA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95401-4122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-521-4500
-----------------------------------------------------
Fax | 707-544-4626
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | A153171
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | P1137
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------