Provider Demographics
NPI:1366513558
Name:RUTH, DARREN
Entity type:Individual
Prefix:
First Name:DARREN
Middle Name:
Last Name:RUTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3717 E THOUSAND OAKS BLVD
Mailing Address - Street 2:#212
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3607
Mailing Address - Country:US
Mailing Address - Phone:805-267-1858
Mailing Address - Fax:805-435-0432
Practice Address - Street 1:3717 E THOUSAND OAKS BLVD
Practice Address - Street 2:#212
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3607
Practice Address - Country:US
Practice Address - Phone:805-267-1858
Practice Address - Fax:805-435-0432
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5890790001Medicare NSC