Provider Demographics
NPI:1366726135
Name:ERVIN P. RUZICS, M.D., INC.
Entity type:Organization
Organization Name:ERVIN P. RUZICS, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERVIN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:RUZICS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-771-8033
Mailing Address - Street 1:16396 ARDSLEY CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-2113
Mailing Address - Country:US
Mailing Address - Phone:714-846-6731
Mailing Address - Fax:
Practice Address - Street 1:1100 W STEWART DR
Practice Address - Street 2:SEB 2ND FLOOR, KIDNEY TRANSPLANT
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3849
Practice Address - Country:US
Practice Address - Phone:714-771-8033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51676174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G516761Medicaid
CAG51676OtherMEDICARE ID
G51676OtherMEDICAL LICENSE NUMBER
G51676OtherMEDICAL LICENSE NUMBER