Healthcare Provider Details

I. General information

NPI: 1316968266
Provider Name (Legal Business Name): STEFAN J RIPICH CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 03/14/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21337 BUSH ST
MIDDLETOWN CA
95461
US

IV. Provider business mailing address

21337 BUSH STREET
MIDDLETOWN CA
95461
US

V. Phone/Fax

Practice location:
  • Phone: 707-987-3311
  • Fax: 707-987-2455
Mailing address:
  • Phone: 707-987-3311
  • Fax: 707-987-2455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5900
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: