Provider Demographics
NPI:1528119971
Name:RUTH, MILTON (LAC)
Entity type:Individual
Prefix:
First Name:MILTON
Middle Name:
Last Name:RUTH
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W BULLARD AVE
Mailing Address - Street 2:A4
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-7610
Mailing Address - Country:US
Mailing Address - Phone:559-322-9821
Mailing Address - Fax:559-322-7821
Practice Address - Street 1:200 W BULLARD AVE
Practice Address - Street 2:A4
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-7610
Practice Address - Country:US
Practice Address - Phone:559-322-9821
Practice Address - Fax:559-322-7821
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7665171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist