Healthcare Provider Details

I. General information

NPI: 1528288719
Provider Name (Legal Business Name): AZUCENA RUFF FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 LOCKHEED WAY BLDG 601 / MEDICAL / ROOM 119/
PALMDALE CA
93599-0199
US

IV. Provider business mailing address

1011 LOCKHEED WAY BLDG 601 / MEDICAL / ROOM 119/ MAIL DROP 0199
PALMDALE CA
93599-0199
US

V. Phone/Fax

Practice location:
  • Phone: 661-572-2191
  • Fax: 661-572-2150
Mailing address:
  • Phone: 661-572-2191
  • Fax: 661-572-2150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN703157
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP17235
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: