Healthcare Provider Details

I. General information

NPI: 1598198897
Provider Name (Legal Business Name): JOSE DEJESUS RUVALCABA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOSE DEJESUS LIMON

II. Dates (important events)

Enumeration Date: 08/10/2013
Last Update Date: 08/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 E FRANCIS AVE
LA HABRA CA
90631-4003
US

IV. Provider business mailing address

813 E FRANCIS AVE
LA HABRA CA
90631-4003
US

V. Phone/Fax

Practice location:
  • Phone: 562-665-4638
  • Fax:
Mailing address:
  • Phone: 562-665-4638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA23065
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: