Healthcare Provider Details

I. General information

NPI: 1063154854
Provider Name (Legal Business Name): RUTH HORTENCIA RAMON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11370 ANDERSON ST STE 3150
LOMA LINDA CA
92354-3450
US

IV. Provider business mailing address

11370 ANDERSON ST STE 3150
LOMA LINDA CA
92354-3450
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-4047
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number390200000X
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberTLL-2025-005
License Number StateGU
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA187959
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: