Provider Demographics
NPI:1366416497
Name:GARG, RUCHIRA (MD)
Entity type:Individual
Prefix:MRS
First Name:RUCHIRA
Middle Name:
Last Name:GARG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 S. SAN VICENTE BOULEVARD
Mailing Address - Street 2:A3600
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048
Mailing Address - Country:US
Mailing Address - Phone:310-423-1153
Mailing Address - Fax:310-423-6795
Practice Address - Street 1:127 S. SAN VICENTE BOULEVARD
Practice Address - Street 2:A3600
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048
Practice Address - Country:US
Practice Address - Phone:310-423-1153
Practice Address - Fax:310-423-6795
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ529372080P0202X
FLME948552080P0202X
CAC 554242080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274385000Medicaid
FLK7151Medicare UPIN
FLAG866ZMedicare PIN