Healthcare Provider Details

I. General information

NPI: 1427621820
Provider Name (Legal Business Name): ANA MICHELLE ROTHHAMMER-RUIZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2021
Last Update Date: 07/22/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 KING ST.
ARBUCKLE CA
95912
US

IV. Provider business mailing address

205 GOLD MINE DR
SAN FRANCISCO CA
94131-2523
US

V. Phone/Fax

Practice location:
  • Phone: 530-619-0800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95015884
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: