Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 20A4620 | CA |
N | 207Q00000X | Family Doctor | 20A4620 | CA |
NPI | 1366573453 |
---|---|
Provider Name | Dr. Raymond John Hruby |
First Address | Alta Loma, CA 91737-1806 |
Second Address | Pomona, CA 91766-1854 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A93587 | (02) | CA |