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NPI Code Detail

MEDICARE: MS. RUBY VILLAVISENCIO MSN, CPNP

MEDICARE: MS. RUBY VILLAVISENCIO MSN, CPNP
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
1363LA2100XAcute Care Nurse Practitioner10927CA
2163W00000XRegistered Nurse508591CA
3363LP0200XPediatric Nurse Practitioner10927CA

General Provider Information

NPI Number : 1881678233
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. RUBY VILLAVISENCIO MSN, CPNP
Provider Business Mailing Address
First Line : 32 CELESTINE CIR
Second Line :
City : LADERA RANCH
State : CA
Zip : 92694-0829
Country : US
Telephone Number : 949-682-6600
Fax Number :
Provider Business Practice Location Address
First Line : 1241 E DYER RD STE 145
Second Line :
City : SANTA ANA
State : CA
Zip : 92705-5694
Country : US
Telephone Number : 949-449-1285
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2005
Last Update Date : 07/21/2020

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