Provider Demographics
NPI:1447686985
Name:FRIEDRICHSDORF, RUTH (MD)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:FRIEDRICHSDORF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 SUNRISE AVE
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-3338
Mailing Address - Country:US
Mailing Address - Phone:612-666-2096
Mailing Address - Fax:
Practice Address - Street 1:61 CAMINO ALTO STE 107
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2910
Practice Address - Country:US
Practice Address - Phone:415-388-6303
Practice Address - Fax:415-388-7136
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA166767208000000X
MN60208208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty