Provider Demographics
NPI:1588359483
Name:BAJAJ, RUBY (PT, DPT)
Entity type:Individual
Prefix:
First Name:RUBY
Middle Name:
Last Name:BAJAJ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6445 FISCHER WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-5804
Mailing Address - Country:US
Mailing Address - Phone:480-290-2368
Mailing Address - Fax:
Practice Address - Street 1:7220 AVENIDA ENCINAS STE 120
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-4660
Practice Address - Country:US
Practice Address - Phone:760-603-9457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301085225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist