| Edmundo Ruiz Davila, M.d.,inc. | |
|
4087 Peralta Blvd Fremont CA 94536-4849 | |
| (510) 793-7555 | |
| (510) 797-5372 |
| Full Name | Edmundo Ruiz Davila, M.d.,inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 4087 Peralta Blvd, Fremont, California |
| Authorized Official Name and Position | Lucille Joanne Mendoza (OFFICE MANAGER) |
| Authorized Official Contact | 5107937555 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Edmundo Ruiz Davila, M.d.,inc. 4087 Peralta Blvd Fremont CA 94536-4849 Ph: (510) 793-7555 | Edmundo Ruiz Davila, M.d.,inc. 4087 Peralta Blvd Fremont CA 94536-4849 Ph: (510) 793-7555 |
| NPI Number | 1245281682 |
|---|---|
| Provider Enumeration Date | 05/12/2006 |
| Last Update Date | 02/25/2014 |
| Medicare PECOS PAC ID | 3476635657 |
|---|---|
| Medicare Enrollment ID | O20080126000151 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245281682 | NPI | - | NPPES |
| 05D0881663 | Other | CA | CLIA # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Edmundo Ruiz Davila |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1699726976 PECOS PAC ID: 8820064678 Enrollment ID: I20040902001511 |
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