Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081S0010X | Sports Medicine | E3866 | CA |
N | 213ES0000X | Sports Medicine | E3866 | CA |
Y | 213ES0103X | Foot & Ankle Surgery | E3866 | CA |
NPI | 1093706590 |
---|---|
Provider Name | Dr. Brad William Ruetenik |
First Address | Solana Beach, CA 92075-1807 |
Second Address | Encinitas, CA 92024-5136 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 05/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U46740 | (02) | CA |