Provider Demographics
NPI:1619961703
Name:HAMAD, RUTH A (MD)
Entity type:Individual
Prefix:DR
First Name:RUTH
Middle Name:A
Last Name:HAMAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 W ROUTE 66
Mailing Address - Street 2:SUITE 208
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-6249
Mailing Address - Country:US
Mailing Address - Phone:626-335-4079
Mailing Address - Fax:626-857-0868
Practice Address - Street 1:130 W ROUTE 66
Practice Address - Street 2:SUITE 208
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-6249
Practice Address - Country:US
Practice Address - Phone:626-335-4079
Practice Address - Fax:626-857-0868
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2010-06-23
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
CAA44303207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A443030Medicaid
CA00A443030Medicaid
CAWA44303EMedicare PIN