Healthcare Provider Details

I. General information

NPI: 1760058622
Provider Name (Legal Business Name): JEANANNE N/A RUCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 EL CAMINO REAL
ATASCADERO CA
93422-2532
US

IV. Provider business mailing address

1207 GRASSY HOLLOW WAY
PASO ROBLES CA
93446-4036
US

V. Phone/Fax

Practice location:
  • Phone: 805-423-8342
  • Fax:
Mailing address:
  • Phone: 805-423-8342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: