Healthcare Provider Details

I. General information

NPI: 1598584732
Provider Name (Legal Business Name): MARIA RUBY VILLAREAL ROYOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RUBY VILLAREAL ROYOLA

II. Dates (important events)

Enumeration Date: 10/04/2024
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 E CLINTON AVE
FRESNO CA
93703-2223
US

IV. Provider business mailing address

10853 BERNADINE AVE
CLOVIS CA
93619-5221
US

V. Phone/Fax

Practice location:
  • Phone: 559-225-6100
  • Fax:
Mailing address:
  • Phone: 510-329-3683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number95253432
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: