Healthcare Provider Details

I. General information

NPI: 1588938880
Provider Name (Legal Business Name): JASMINE CHAN-RUIZ PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2012
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 ORANGEFAIR MALL
FULLERTON CA
92832-3038
US

IV. Provider business mailing address

3086 E COALINGA DR
BREA CA
92821-9109
US

V. Phone/Fax

Practice location:
  • Phone: 650-743-6456
  • Fax:
Mailing address:
  • Phone: 650-743-6456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number38572
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: