Healthcare Provider Details

I. General information

NPI: 1952882573
Provider Name (Legal Business Name): JUSTE RUZELYTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 S BRISTOL ST STE 100
SANTA ANA CA
92704-7319
US

IV. Provider business mailing address

32764 OCEAN VISTA CT
DANA POINT CA
92629-4003
US

V. Phone/Fax

Practice location:
  • Phone: 714-957-6030
  • Fax:
Mailing address:
  • Phone: 949-295-3119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number103108
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: