MEDICARE: MS. RUTH KOPPEL ROSENBLUM RN, NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	RN 449701	CA
2	363LP0200X	Pediatric Nurse Practitioner	NP 8679	CA

General Provider Information

NPI Number	:	1588878177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RUTH KOPPEL ROSENBLUM RN, NP

Provider Business Mailing Address
First Line	:	1521 ESTELLE AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95118-1325
Country	:	US
Telephone Number	:	408-267-0174
Fax Number	:

Provider Business Practice Location Address
First Line	:	1521 ESTELLE AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95118-1325
Country	:	US
Telephone Number	:	408-267-0174
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	07/08/2007

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