Organization
EMERGENCY MED ASSOC CHO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY RUTHERFORD MD (HEAD OF DEPT)
(510) 428-3259
Entity
Organization
Contact information
Practice address
747 52ND ST, OAKLAND, CA 94609-1809
(510) 428-3259
(510) 450-5836
Mailing address
3116 W MARCH LN, STE 200, STOCKTON, CA 95219-2369
(209) 473-6555
(209) 473-6543
Taxonomy
Speciality
Code
Description
License number
State
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
G43608
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G43608
DR. RUTHERFORD'S CA MD LI
CA
01
—
GR0095780
MEDI-CAL
CA
Enumeration date
02/23/2007
Last updated
08/22/2020
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