Isis Burakom Rutledge, LMT

Primary specialty

ContractorTaxonomy code 171W00000X

License

68684 Issued in CA

Practice address

4520 Executive Dr
Ste 225
San Diego, CA 92121-3018

Phone

(619) 323-4089

NPI assigned

Apr 9, 2009

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1239235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476144000000",
    "number": "1235372020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 ROSECRANS ST",
            "address_2": "#120",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921062674",
            "telephone_number": "619-323-4089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4520 EXECUTIVE DR",
            "address_2": "STE 225",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921213018",
            "telephone_number": "619-323-4089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUTLEDGE",
        "first_name": "ISIS",
        "middle_name": "BURAKOM",
        "name_prefix": "Mrs.",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-04-09",
        "last_updated": "2016-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": "CO",
            "license": "4969",
            "primary": false
        },
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": "CA",
            "license": "68684",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ruthiva LLC
• Alissa A Rutkoski, D.C.
• Kenneth Todd Rutkowski, P.T.
• Mary Rutland, LCSW
• Hilary Joyce Rutledge, DC
• Kari Lynn Rutledge, SLPA
• Josephine Ann Rutschman
• Walter Levy Rutschow
• Candice April Ruttner - Duryea, MFT
• Charissa A Ruud, L.C.S.W.

• Contractor in San Diego, CA
• Providers in San Diego, CA by specialty
• Contractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.