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NPI Code Detail

MEDICARE: DR. JOANNA CARR RUTHENBERG M.D.

MEDICARE: DR. JOANNA CARR RUTHENBERG M.D.
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
1208000000XPediatrics PhysicianA80604CA

General Provider Information

NPI Number : 1669481214
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOANNA CARR RUTHENBERG M.D.
Provider Business Mailing Address
First Line : 3100 TELEGRAPH AVE STE 2103
Second Line :
City : OAKLAND
State : CA
Zip : 94609-3210
Country : US
Telephone Number : 510-452-5231
Fax Number : 510-869-6679
Provider Business Practice Location Address
First Line : 2950 INTERNATIONAL BLVD
Second Line :
City : OAKLAND
State : CA
Zip : 94601-2228
Country : US
Telephone Number : 510-535-4400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2006
Last Update Date : 11/20/2012

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