Provider Demographics
NPI:1750343604
Name:RUTGERS, JOANNE K L (MD)
Entity type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:K L
Last Name:RUTGERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8700 BEVERLY BLVD
Mailing Address - Street 2:DEPT. OF PATHOLOGY
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1804
Mailing Address - Country:US
Mailing Address - Phone:310-423-6623
Mailing Address - Fax:310-423-0122
Practice Address - Street 1:8700 BEVERLY BLVD
Practice Address - Street 2:DEPT OF PATHOLOGY
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:310-423-6623
Practice Address - Fax:310-423-0122
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG60455207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G604550Medicaid
CAWG60455DMedicare PIN
CAWG60455CMedicare PIN
CAA57886Medicare UPIN