Provider Demographics
NPI:1487945739
Name:RUTHIVA LLC
Entity type:Organization
Organization Name:RUTHIVA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:G
Authorized Official - Last Name:SLAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-241-4616
Mailing Address - Street 1:10601 TIERRASANTA BLVD
Mailing Address - Street 2:STE G-188
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-2616
Mailing Address - Country:US
Mailing Address - Phone:619-241-4616
Mailing Address - Fax:858-569-6917
Practice Address - Street 1:10601 TIERRASANTA BLVD
Practice Address - Street 2:STE G-188
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124-2616
Practice Address - Country:US
Practice Address - Phone:619-241-4616
Practice Address - Fax:858-569-6917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier