Healthcare Provider Details

I. General information

NPI: 1780087288
Provider Name (Legal Business Name): NATALIE RUGGIERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATALIE JOHNSON

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 03/07/2023
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 E HERNDON AVE
FRESNO CA
93720-3391
US

IV. Provider business mailing address

1630 E HERNDON AVE
FRESNO CA
93720-3391
US

V. Phone/Fax

Practice location:
  • Phone: 559-256-5200
  • Fax:
Mailing address:
  • Phone: 559-256-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: