Healthcare Provider Details

I. General information

NPI: 1154016129
Provider Name (Legal Business Name): SARAH ELIZABETH RUZICKA RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 PLACER ST
REDDING CA
96001-1170
US

IV. Provider business mailing address

2578 EASTBROOK DR
REDDING CA
96002-5146
US

V. Phone/Fax

Practice location:
  • Phone: 530-246-5710
  • Fax:
Mailing address:
  • Phone: 530-209-0487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number1080
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number29114
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: