Provider Demographics
NPI:1568475044
Name:RUBY, RONALD J (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:J
Last Name:RUBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 N SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-5948
Mailing Address - Country:US
Mailing Address - Phone:310-545-6627
Mailing Address - Fax:310-545-0352
Practice Address - Street 1:1101 N SEPULVEDA BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-5948
Practice Address - Country:US
Practice Address - Phone:310-545-6627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34101207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0064100Medicaid
CA00G341010Medicaid
CAW13398AMedicare PIN
CAGR0064100Medicaid
CAW13398BMedicare PIN
CA00G341010Medicaid