MEDICARE: RUTH ELIZABETH LANDSBERGER 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	207Q00000X	Family Medicine Physician	A54044	CA

General Provider Information

NPI Number	:	1629120001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH ELIZABETH LANDSBERGER MD

Provider Business Mailing Address
First Line	:	837 S FAIR OAKS AVE
Second Line	:	SUITE 204
City	:	PASADENA
State	:	CA
Zip	:	91105-2628
Country	:	US
Telephone Number	:	626-398-6300
Fax Number	:	626-204-0086

Provider Business Practice Location Address
First Line	:	1800 N LAKE AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104-1228
Country	:	US
Telephone Number	:	626-398-6300
Fax Number	:	626-204-0086

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	11/21/2011

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