MEDICARE: DR. WILLIAM ALBERT DERUSO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	44212	AZ
2	2085R0202X	Diagnostic Radiology Physician	A101578	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A101578	OTHER	CA	BS OF CA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316127145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM ALBERT DERUSO MD

Provider Business Mailing Address
First Line	:	DEPT LA 21613
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91185-1613
Country	:	US
Telephone Number	:	949-263-8620
Fax Number	:	800-409-7005

Provider Business Practice Location Address
First Line	:	2320 BATH ST STE 113
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-4377
Country	:	US
Telephone Number	:	805-682-7744
Fax Number	:	805-682-3321

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2007
Last Update Date	:	10/30/2012

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