Healthcare Provider Details

I. General information

NPI: 1336696988
Provider Name (Legal Business Name): FREYA CERNA RUDA APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8191 TIMBERLAKE WAY STE 350
SACRAMENTO CA
95823-5419
US

IV. Provider business mailing address

5316 TERSK WAY
ELK GROVE CA
95757-3224
US

V. Phone/Fax

Practice location:
  • Phone: 916-688-9994
  • Fax:
Mailing address:
  • Phone: 224-302-2513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95008941
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209014686
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: