MEDICARE: DR. RUTH L POLAN 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	G44076	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629048350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUTH L POLAN MD

Provider Business Mailing Address
First Line	:	2190 LYNN RD
Second Line	:	SUITE 220
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360-1980
Country	:	US
Telephone Number	:	805-495-8050
Fax Number	:	805-496-2160

Provider Business Practice Location Address
First Line	:	227 W JANSS RD
Second Line	:	SUITE 150
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360-1848
Country	:	US
Telephone Number	:	805-496-7755
Fax Number	:	805-379-3913

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	08/11/2011

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