Healthcare Provider Details

I. General information

NPI: 1811052418
Provider Name (Legal Business Name): RUTH JAMORALIN MENDEZ N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 N PARK AVE
POMONA CA
91768-3002
US

IV. Provider business mailing address

4130 N MORADA AVE
COVINA CA
91722-3921
US

V. Phone/Fax

Practice location:
  • Phone: 909-622-2945
  • Fax:
Mailing address:
  • Phone: 626-960-0878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberNP6722
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: