Healthcare Provider Details

I. General information

NPI: 1467363556
Provider Name (Legal Business Name): RUTHANN BIVOLCIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15954 LOS GATOS BLVD
LOS GATOS CA
95032-3424
US

IV. Provider business mailing address

395 DENALI DR
MORGAN HILL CA
95037-5373
US

V. Phone/Fax

Practice location:
  • Phone: 669-233-4040
  • Fax:
Mailing address:
  • Phone: 408-718-0972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0121X
TaxonomyPlastic Surgery Registered Nurse
License Number439108
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: