Provider Demographics
NPI:1174552673
Name:SOROTZKIN, RUTH ADINA (MD)
Entity type:Individual
Prefix:DR
First Name:RUTH
Middle Name:ADINA
Last Name:SOROTZKIN
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:2811 WILSHIRE BLVD
Mailing Address - Street 2:#800
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4803
Mailing Address - Country:US
Mailing Address - Phone:310-566-6330
Mailing Address - Fax:310-566-6320
Practice Address - Street 1:1811 WILSHIRE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5626
Practice Address - Country:US
Practice Address - Phone:310-566-6330
Practice Address - Fax:310-566-6320
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG70184207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0071940Medicaid
CAE 86781Medicare UPIN
CAGR0071940Medicaid