Healthcare Provider Details

I. General information

NPI: 1376725630
Provider Name (Legal Business Name): MAURO B RUFFY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2585 SAMARITAN DR
SAN JOSE CA
95124-4107
US

IV. Provider business mailing address

2585 SAMARITAN DR
SAN JOSE CA
95124-4107
US

V. Phone/Fax

Practice location:
  • Phone: 408-871-3400
  • Fax:
Mailing address:
  • Phone: 408-871-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberA80193
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: