Provider Demographics
NPI:1629019583
Name:RITHAPORN, RUTHACHAE (MD)
Entity type:Individual
Prefix:DR
First Name:RUTHACHAE
Middle Name:
Last Name:RITHAPORN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:
Other - Last Name:RITHAPORN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2814 CELESTE AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-3431
Mailing Address - Country:US
Mailing Address - Phone:559-916-5161
Mailing Address - Fax:559-896-8792
Practice Address - Street 1:2814 CELESTE AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-3431
Practice Address - Country:US
Practice Address - Phone:559-916-5161
Practice Address - Fax:559-896-8792
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A342960174400000X
CAA342960207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA27441Medicare UPIN