Organization
RUTHIVA LLC
Active
Other names
Wig Van
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK G SLAGLE (MANAGING MEMBER)
(619) 241-4616
Entity
Organization
Contact information
Practice address
10601 TIERRASANTA BLVD, STE G-188, SAN DIEGO, CA 92124-2616
(619) 241-4616
(858) 569-6917
Mailing address
10601 TIERRASANTA BLVD, STE G-188, SAN DIEGO, CA 92124-2616
(619) 241-4616
(858) 569-6917
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
04/20/2011
Last updated
04/20/2011
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