Healthcare Provider Details

I. General information

NPI: 1598569105
Provider Name (Legal Business Name): JASSON EMMANUEL RUIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 N PERRIS BLVD STE C
PERRIS CA
92571-2509
US

IV. Provider business mailing address

28806 MALTBY AVE
MORENO VALLEY CA
92555-6919
US

V. Phone/Fax

Practice location:
  • Phone: 519-715-5050
  • Fax: 951-715-5050
Mailing address:
  • Phone: 213-374-4996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-DLJIEZ
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: