Healthcare Provider Details

I. General information

NPI: 1588538417
Provider Name (Legal Business Name): RUMAR HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S 97TH ST APT G204
MESA AZ
85208-1962
US

IV. Provider business mailing address

105 S 97TH ST APT G204
MESA AZ
85208-1962
US

V. Phone/Fax

Practice location:
  • Phone: 860-884-6285
  • Fax: 860-884-6285
Mailing address:
  • Phone: 860-884-6285
  • Fax: 860-884-6285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: RUTH YAMILE MARCELLUS
Title or Position: DIRECTOR
Credential: PA
Phone: 860-884-6285