Healthcare Provider Details

I. General information

NPI: 1801267083
Provider Name (Legal Business Name): JESSICA RUIZ CUEN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 12/14/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SOUTH IMPERIAL AVENUE SUITE 3
EL CENTRO CA
92243-4242
US

IV. Provider business mailing address

815 WESTWIND DRIVE
EL CENTRO CA
92243-4363
US

V. Phone/Fax

Practice location:
  • Phone: 760-339-2802
  • Fax: 760-355-9520
Mailing address:
  • Phone: 760-554-1503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95003279
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: