Provider Demographics
NPI:1487980538
Name:M. THERESA RUSCH, M.D., INC
Entity type:Organization
Organization Name:M. THERESA RUSCH, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:RUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-781-5022
Mailing Address - Street 1:396 W PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3323
Mailing Address - Country:US
Mailing Address - Phone:559-781-5022
Mailing Address - Fax:559-781-6990
Practice Address - Street 1:396 W PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3323
Practice Address - Country:US
Practice Address - Phone:559-781-5022
Practice Address - Fax:559-781-6990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51083261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C51083Medicaid