1427043512 NPI number — FERNANDO J PARTIDA RUESSGA MD

Table of content: FERNANDO J PARTIDA RUESSGA MD (NPI 1427043512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427043512 NPI number — FERNANDO J PARTIDA RUESSGA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARTIDA RUESSGA
Provider First Name:
FERNANDO
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427043512
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8055 173RD ST W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEVILLE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55044-9541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-985-5258
Provider Business Mailing Address Fax Number:
952-431-9651

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14135 CEDAR AVE
Provider Second Line Business Practice Location Address:
STE 300
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55124-4522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-431-9655
Provider Business Practice Location Address Fax Number:
952-431-9651
Provider Enumeration Date:
09/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  028626 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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