Healthcare Provider Details

I. General information

NPI: 1225953474
Provider Name (Legal Business Name): JESUS TAPIA TAPI RUIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ERICKT TAPIA

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 E RIVERSIDE DR SPC 81
ONTARIO CA
91761-7259
US

IV. Provider business mailing address

1855 E RIVERSIDE DR SPC 81
ONTARIO CA
91761-7259
US

V. Phone/Fax

Practice location:
  • Phone: 909-542-7507
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95038405
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: