MEDICARE: INFINITY PHYSICIAN ASSOCIATES

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	208D00000X	General Practice Physician
2	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1558854976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFINITY PHYSICIAN ASSOCIATES

Provider Business Mailing Address
First Line	:	3012 SAN GABRIEL BLVD
Second Line	:
City	:	ROSEMEAD
State	:	CA
Zip	:	91770-2536
Country	:	US
Telephone Number	:	626-572-8692
Fax Number	:	626-572-9736

Provider Business Practice Location Address
First Line	:	3012 SAN GABRIEL BLVD
Second Line	:
City	:	ROSEMEAD
State	:	CA
Zip	:	91770
Country	:	US
Telephone Number	:	626-572-8692
Fax Number	:	626-572-9736

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RUBEN M RUIZ III
Credential	:	M. D.
Telephone Number	:	626-321-5755

Provider Enumeration Date	:	06/11/2018
Last Update Date	:	06/14/2018

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