Healthcare Provider Details

I. General information

NPI: 1992837868
Provider Name (Legal Business Name): MRS. ROSEMARIE S RUIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 HIGH ST STE C
DELANO CA
93215
US

IV. Provider business mailing address

PO BOX 1559 ATTENTION ANN LEE CLINICA SIERRA VISTA
BAKERSFIELD CA
93302-1559
US

V. Phone/Fax

Practice location:
  • Phone: 661-725-2788
  • Fax: 661-725-1957
Mailing address:
  • Phone: 661-635-3050
  • Fax: 661-869-1503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1192
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: