Healthcare Provider Details

I. General information

NPI: 1699213116
Provider Name (Legal Business Name): JESSICA RUIZ-ROSAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52190 AVENIDA RUBIO
LA QUINTA CA
92253-3289
US

IV. Provider business mailing address

52190 AVENIDA RUBIO
LA QUINTA CA
92253-3289
US

V. Phone/Fax

Practice location:
  • Phone: 760-285-4329
  • Fax:
Mailing address:
  • Phone: 760-285-4329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: