Provider Demographics
NPI:1962544551
Name:SCHACK, RUTH ANNETTE (MD)
Entity type:Individual
Prefix:DR
First Name:RUTH
Middle Name:ANNETTE
Last Name:SCHACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:400 NEWPORT CENTER DR
Mailing Address - Street 2:SUITE 706
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7601
Mailing Address - Country:US
Mailing Address - Phone:949-640-4033
Mailing Address - Fax:949-721-9572
Practice Address - Street 1:400 NEWPORT CENTER DR
Practice Address - Street 2:SUITE 706
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7601
Practice Address - Country:US
Practice Address - Phone:949-640-4033
Practice Address - Fax:949-721-9572
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG730532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry